Split liver transplantation: Current developments

Abstract

In 1988, Rudolf Pichlmayr pioneered split liver transplantation (SLT), enabling the transplantation of one donor liver into two recipients - one pediatric and one adult patient. In the same year, Henri Bismuth and colleagues performed the first full right/full left split procedure with two adult recipients. Both splitting techniques were rapidly adopted within the transplant community. However, a SLT is technically demanding, may cause increased perioperative complications, and may potentially transform an excellent deceased donor organ into two marginal quality grafts. Thus, crucial evaluation of donor organs suitable for splitting and careful screening of potential SLT recipients is warranted. Furthermore, the logistic background of the splitting procedure as well as the organ allocation policy must be adapted to further increase the number and the safety of SLT. Under defined circumstances, in selected patients and at experienced transplant centers, SLT outcomes can be similar to those obtained in full organ LT. Thus, SLT is an important tool to reduce the donor organ shortage and waitlist mortality, especially for pediatric patients and small adults. The present review gives an overview of technical aspects, current developments, and clinical outcomes of SLT.

Keywords: Extended right lobe; In situ split; Left lateral lobe; Liver transplantation; Living donor; Organ shortage.

Figure 1

Graft survival of liver transplants in 0-17-year-old pediatric patients by transplant year from 1995-2016. Collaborative Transplant Study data are derived from 95 transplant centers in 22 countries (87% European transplants).

Figure 2

Different pediatric age groups and distribution of liver transplants by transplant year from 1995-2016.

Figure 3

Pediatric (A) and split or reduced liver transplants from living or deceased donors (B) and all liver transplants categorized according to graft size (C) by transplant year from 1995-2016.

Figure 4

Scheme of a “classical” extended right lobe/left lateral lobe split (yellow line) and a full left/full right split (black line).

Figure 5

Split or reduced liver transplants from 1995-2016 categorized according to graft size.

Figure 6

Split or reduced liver transplants from 1995-2016 from deceased donors categorized according to (A) graft size, (B) recipient age, and (C) from living donors categorized according to recipient age.

Figure 7

Distribution of donor age according to transplant year (A) and recipient age (B) in deceased donor split or reduced liver transplantations performed from 1995-2016.