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Split-liver transplantation The Paul Brousse policy Azoulay D; Astarcioglu I; Bismuth H; Castaing D; Majno P; Adam R; Johann MAnn Surg 1996[Dec]; 224 (6): 737-46; discussion 746-8OBJECTIVE: The authors objective is to report their recent experience with split-liver transplantation, focusing on the results and the impact on organ shortage. SUMMARY BACKGROUND DATA: There is an insufficient number of organs for liver transplantation. Split-liver transplantation is a method to increase the number of grafts, but the procedure is slow to gain wide acceptance because of its complexity and the poor results reported in previous series. METHODS: During the year 1995, the authors split 20 of 83 transplantable livers allocated to the authors' center, generating 40 grafts: 23 were transplanted locally and 17 were given to partner centers. During the same period, the authors accepted four split-liver grafts proposed to them by other centers. Overall, 27 split-liver transplantations were done in the authors' unit, accounting for 30% of the 90 transplants performed in 1995. RESULTS: One-year patient and graft survival rates for split-liver transplantation were 79.4% and 78.5%, respectively. Arterial and biliary complications rates were 15% and 22%, respectively, with none leading to graft loss. Primary nonfunction occurred in one case (4%). By splitting 24 of 87 transplantable livers (4 of which were in partner units), a total of 111 transplantations were performed, increasing graft availability by 28%. CONCLUSIONS: Split-liver transplantation is achieving graft and patient survival rates similar to that of whole liver transplantation despite a higher incidence of complications, which could become less frequent as experience is gained with this procedure. A wider acceptance of split-liver transplantation could markedly increase the supply of liver grafts.|Adult[MESH]|Female[MESH]|Graft Survival[MESH]|Hepatic Artery/anatomy & histology[MESH]|Hepatic Encephalopathy/*surgery[MESH]|Humans[MESH]|Infant[MESH]|Liver Transplantation/adverse effects/*methods/mortality[MESH]|Male[MESH]|Middle Aged[MESH]|Portal Vein/anatomy & histology[MESH]|Postoperative Complications[MESH]|Tissue and Organ Procurement[MESH]|Treatment Outcome[MESH]|Vascular Patency[MESH]|Vascular Surgical Procedures/adverse effects[MESH] |
