Feasibility and Safety of Split-Liver Transplantation in a Nascent Framework of Deceased Donation
| Autor: | Ilankumaran Kaliamoorthy, Rajesh Rajalingam, Mohamed Rela, Venugopal Kota, Gomathy Narasimhan, Mettu Srinivas Reddy, Ramkiran Cherukuru, Vasanthakumar Gunasekaran, Naresh Shanmugam |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Tissue and Organ Procurement Adolescent medicine.medical_treatment Kaplan-Meier Estimate 030230 surgery Liver transplantation Severity of Illness Index End Stage Liver Disease 03 medical and health sciences Liver disease Young Adult 0302 clinical medicine Postoperative Complications Severity of illness medicine Humans Prospective Studies Young adult Prospective cohort study Child Survival rate Transplantation Hepatology business.industry Infant Perioperative Middle Aged medicine.disease Allografts Surgery Liver Transplantation Survival Rate Treatment Outcome Child Preschool Tissue and Organ Harvesting Feasibility Studies 030211 gastroenterology & hepatology Female business |
| Zdroj: | Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 25(3) |
| ISSN: | 1527-6473 |
| Popis: | Split-liver transplantation (SLT) is a valuable option for optimizing the use of good-quality deceased donor grafts. It is not routinely reported outside the West because of limited deceased donor numbers, technical and organizational constraints, lack of experience, and a predominant living donor liver transplantation (LDLT) practice. At our center, 20% of the liver transplantations (LTs) are from deceased donors. We report our experience of SLT and compare outcomes with pediatric and adult LDLT recipients. A prospectively maintained database of all LT recipients between September 2009 and March 2017 was analyzed. Each pediatric SLT recipient was matched to 2 pediatric LDLT recipients for age, weight, urgency, and year of transplant. Each adult SLT recipient was similarly matched to 2 adult LDLT recipients for age, Model for End-Stage Liver Disease score, and year of transplant. Intraoperative and postoperative parameters, including recovery time, morbidity (biliary and vascular complications, Clavien grade >IIIA complications), and mortality were compared. In total, 40 SLTs were performed after splitting 20 deceased donor livers (in situ, n = 11; hybrid split, n = 3; and ex vivo, n = 6). Recipients included 22 children and 18 adults. There were 18 livers that were split conventionally (extended right lobe and left lateral segment [LLS]), and 2 were right lobe-left lobe SLTs. Also, 3 LLS grafts were used as auxiliary grafts for metabolic liver disease. Perioperative mortality in SLT recipients occurred in 3 patients (2 children and 1 adult). Incidence of vascular, biliary, and Clavien grade >IIIA complications were similar between matched adult and pediatric SLT and LDLT groups. In conclusion, SLT is an effective technique with outcomes comparable to living donor grafts for adult and pediatric recipients. Using SLT techniques at centers with limited deceased donors optimizes the use of good-quality whole grafts and reduces the gap between organ demand and availability. |
| Databáze: | OpenAIRE |
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