Full-Right Full-Left Split Liver Transplantation for Two Adult Recipients: A Single-Center Experience in China

Abstract

Background: The most effective treatment for end-stage liver diseases is liver transplantation, which is impeded by the shortage of donor livers. Split liver transplantation (SLT) is important for addressing the donor liver shortage. However, full-right full-left SLT for two adult recipients is globally rarely conducted. This study aimed to investigate the clinical outcomes of this technique.

Methods: We retrospectively analyzed the clinical data of 22 recipients who underwent full-right full-left SLT at Shulan (Hangzhou) Hospital between January, 2021 and September, 2022. The graft-to-recipient weight ratio (GRWR), cold ischemia time, operation time, length of the anhepatic phase, intraoperative blood loss, and red blood cell transfusion amount were all analyzed. The differences in liver function recovery after transplantation were compared between the left and right hemiliver groups. The postoperative complications and prognosis of the recipients were also analyzed.

Results: The livers of 11 donors were transplanted into 22 adult recipients. The GRWR ranged from 1.16-1.65%, the cold ischemia time was 282.86 ± 134.87 min, the operation time was 371.32 ± 75.36 min, the anhepatic phase lasted 60.73 ± 19.00 min, the intraoperative blood loss was 759.09 ± 316.84 mL, and the red blood cell transfusion amount was 695.45 ± 393.67 mL. No significant difference in the levels of liver function markers, total bilirubin, aspartate aminotransferase, or alanine aminotransferase between left and right hemiliver groups at 1, 3, 5, 7, 14, and 28 d postoperatively was observed (both p > 0.05). One recipient developed bile leakage 10 d after transplantation, which improved with endoscopic retrograde cholangiopancreatography-guided nasobiliary drainage and stent placement. Another developed portal vein thrombosis 12 d after transplantation and underwent portal vein thrombectomy and stenting to restore portal vein blood flow. A color Doppler ultrasound performed 2 d after transplantation revealed hepatic artery thrombosis in one patient, and thrombolytic therapy was administered to restore hepatic artery blood flow. The liver function of other patients recovered quickly after transplantation.

Conclusions: Full-right full-left SLT for two adult patients is an efficient way to increase the donor pool. It is safe and feasible with careful donor and recipient selection. Transplant hospitals with highly experienced surgeons in SLT are recommended to promote using full-right full-left SLT for two adult recipients.

Keywords: complete splitting and reconstruction; inferior vena cava; middle hepatic vein; split liver transplantation.

Figure 1

(A) The hepatic veins of Segments V and VIII were retained in the right hemiliver and reconstructed with iliac artery. (B) No obvious ischemia and congestion were seen after implantation. (C) The hepatic veins of Segments V and VIII were retained in the right hemiliver and reconstructed with iliac vein. (D) MHV and RHV reconstruction.

Figure 2

(A) After transection of the liver parenchyma and bile duct. (B) The retrohepatic inferior vena cava (IVC) was divided by longitudinal transection of the front and back walls. (C) Reconstruction of the MHV and IVC in the right hemiliver graft. (D) Reconstruction of the MHV and IVC in the left hemiliver graft.

Figure 3

(A) Venoplasty of the right hepatic vein and inferior right hepatic vein.(B) Segments V and VIII were separately transected during the middle hepatic vein (MHV) splitting. (C) Middle hepatic veins (Segments V and VIII) were bridged and reconstructed. (D) The MHV drainage of the right hemiliver graft was good, and no obvious ischemia and congestion were noted after implantation.

Figure 4

At the time of discharge, no obvious ischemia and congestion were seen in the segments of both the left and right hemilivers near the splitting plane ((A) Left hemiliver; (B) Right hemiliver).