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Ding L, Yu X, Zhang R, Qian J, Zhang W, Wu Q, Zhou L, Yang Z, Zheng S. Full-Right Full-Left Split Liver Transplantation for Two Adult Recipients: A Single-Center Experience in China. J Clin Med 2023; 12:3782. [PMID: 37297977 PMCID: PMC10253538 DOI: 10.3390/jcm12113782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
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.
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Affiliation(s)
- Limin Ding
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.D.); (X.Y.); (J.Q.); (Q.W.)
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou 310003, China;
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, China
| | - Xizhi Yu
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.D.); (X.Y.); (J.Q.); (Q.W.)
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou 310003, China;
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, China
| | - Rui Zhang
- Fuzhou Medical College, Nanchang University, Fuzhou 344000, China;
| | - Junjie Qian
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.D.); (X.Y.); (J.Q.); (Q.W.)
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou 310003, China;
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, China
| | - Wu Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310022, China;
| | - Qinchuan Wu
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.D.); (X.Y.); (J.Q.); (Q.W.)
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou 310003, China;
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, China
| | - Lin Zhou
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou 310003, China;
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Zhe Yang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310022, China;
| | - Shusen Zheng
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.D.); (X.Y.); (J.Q.); (Q.W.)
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou 310003, China;
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China
- Key Laboratory of Organ Transplantation, Hangzhou 310003, China
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310022, China;
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Lau NS, Jacques A, McCaughan G, Crawford M, Liu K, Pulitano C. Addressing the challenges of split liver transplantation through technical advances. A systematic review. Transplant Rev (Orlando) 2021; 35:100627. [PMID: 34052472 DOI: 10.1016/j.trre.2021.100627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/08/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Split liver transplantation addresses donor shortages by facilitating the transplant of two recipients using one donor liver. Some still consider these grafts inferior due to prolonged cold ischaemia time and at times difficult vascular reconstruction. Techniques such as in-situ splitting, machine perfusion and interposition grafts may address these challenges and thereby address these concerns. The aim of this review is to assess these technical advances in split liver transplantation, their utility and outcomes. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Keywords included 'split liver transplantation', 'arterial reconstruction', and 'machine perfusion'. Data found was synthesised into sections including: methods of splitting, full-left full-right splitting, donor cholangiography, machine perfusion and arterial reconstruction. RESULTS A total of 78 articles met inclusion criteria after screening of 151 eligible articles. These were subdivided into the following categories: in-situ (25), ex-vivo (25), full-left full-right splitting (15), donor cholangiography (2), machine perfusion (6), and arterial reconstruction (5). The in-situ splitting technique reduces the cold ischaemia time compared to the ex-vivo technique which may improve graft quality and liver splitting during normothermic machine perfusion is a novel technique with the potential to incorporate the best aspects of both techniques. Interposition grafts are often required during split liver transplantation but have an increased risk of hepatic artery thrombosis. CONCLUSION Advancements in technique have allowed many of the unique challenges of split liver transplantation to be overcome. Overall, this supports the use of split liver transplantation in broader and riskier settings and we advocate for liver transplant surgeons to not hesitate in using these grafts liberally and expanding their recipient selection criteria.
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Affiliation(s)
- Ngee-Soon Lau
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales 2050, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Andrew Jacques
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales 2050, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Geoffrey McCaughan
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales 2050, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Michael Crawford
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales 2050, Australia
| | - Ken Liu
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales 2050, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Carlo Pulitano
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, New South Wales 2050, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia.
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Cahalane AM, Mojtahed A, Sahani DV, Elias N, Kambadakone AR. Pre-hepatic and pre-pancreatic transplant donor evaluation. Cardiovasc Diagn Ther 2019; 9:S97-S115. [PMID: 31559157 DOI: 10.21037/cdt.2018.09.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Innovations in surgical techniques coupled with advances in medical and pharmacological management in the past few decades have enabled organ transplantation to become integral to the management of end stage organ failure. In this review article, we will review the role of the radiologist in the work up of liver and pancreas donors during evaluation of their donor candidacy. The critical role of imaging in assessing the parenchymal, biliary and vascular anatomy in liver donor candidates will be reviewed, as well as highlighting the anatomical findings that may pose a contraindication to transplantation. The limited role of imaging in pancreas donor evaluation is also covered, as well as a brief overview of the surgical techniques available and how the radiologist's findings influence operative technique selection.
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Affiliation(s)
- Alexis M Cahalane
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amirkasra Mojtahed
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Dushyant V Sahani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nahel Elias
- Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Avinash R Kambadakone
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Herden U, Fischer L, Sterneck M, Grabhorn E, Nashan B. Long-term follow-up after full-split liver transplantation and its applicability in the recent transplant era. Clin Transplant 2018; 32:e13205. [DOI: 10.1111/ctr.13205] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Uta Herden
- Department of Hepatobiliary Surgery and Transplantation; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Martina Sterneck
- Outpatient Centre; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Enke Grabhorn
- Department of Paediatric Hepatology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Bjoern Nashan
- Department of Hepatobiliary Surgery and Transplantation; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
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Sguinzi R, Ferla F, De Carlis R, Andorno E, Aseni P, De Carlis L. Split liver technique with middle hepatic vein reconstruction on livers from transplant hepatectomies: a useful tool for surgical improvement. Updates Surg 2018; 70:491-494. [PMID: 29380302 DOI: 10.1007/s13304-018-0512-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/20/2018] [Indexed: 11/25/2022]
Abstract
Livers removed during transplant hepatectomies could represent a useful anatomic ex vivo resource for surgical training, since they are intact and not altered by post-mortem changes yet. The aim of this study is to investigate the effectiveness of such kind of surgical training applied on some hepatic surgery techniques. In the present paper, we focused on split liver operation and middle hepatic vein (MHV) bipartition/reconstruction, since these procedures have a quite long learning curve. Seven native livers were submitted to split liver procedure by a senior resident assisted by a fully trained hepatic surgeon. Pre-splitting ultrasound mapping was compared to pre-operative CT scan. The whole graft was divided into two hemi-livers and the MHV into two hemi-confluents and reconstructed by venous or arterial patches obtained by deceased donor iliac homograft. Water tightness of the anastomosis was confirmed by hydro-pneumatic test and bench portal perfusion. Reduction in operating time was considered an indirect indicator of surgical skill improvement. In all cases, the US confirmed the anatomical distribution of MHV tributaries observed by pre-transplant CT scan. The "ex situ" splitting procedures and MHV bipartition and reconstruction were performed in all native livers in the usual time required for liver transplantation bench surgery (range 50-75 min). Liver grafts removed during hepatectomy could represent a useful resource of intact organs to perform surgical training and boost surgical confidence. In our initial experience, the study of venous drainage of the MHV and application of liver splitting technique and MHV reconstruction resulted technically feasible.
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Affiliation(s)
- Raffaella Sguinzi
- Niguarda Ca' Granda Hospital, General and Transplantation Surgery, Niguarda Transplant Centre, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Fabio Ferla
- Niguarda Ca' Granda Hospital, General and Transplantation Surgery, Niguarda Transplant Centre, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Riccardo De Carlis
- Niguarda Ca' Granda Hospital, General and Transplantation Surgery, Niguarda Transplant Centre, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
- Department of Surgical Sciences Pavia, University of Pavia, Corso Strada Nuova 106, 27100, Pavia, Italy
| | - Enzo Andorno
- Department of General Surgery, San Martino Hospital IRCCS, Largo G. Benzi 10, 16132, Genova, Italy
| | - Paolo Aseni
- Niguarda Ca' Granda Hospital, General and Transplantation Surgery, Niguarda Transplant Centre, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Luciano De Carlis
- Niguarda Ca' Granda Hospital, General and Transplantation Surgery, Niguarda Transplant Centre, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
- School of Medicine, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy
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Right Extended Split Liver Transplantation Compared With Whole Liver Transplantation: Lessons Learned at a Single Center in Latin America—Results From a Match Case-Control Study. Transplant Proc 2017; 49:2122-2128. [DOI: 10.1016/j.transproceed.2017.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/12/2017] [Accepted: 07/30/2017] [Indexed: 01/13/2023]
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Vicentine FPP, Gonzalez AM, Azevedo RAD, Benini BB, Linhares MM, Lopes-Filho GDJ, Martins JL, Salzedas-Netto AA. PEDIATRIC LIVER TRANSPLANTATION WITH EX-SITU LIVER TRANSECTION AND THE APPLICATION OF THE HUMAN FIBRINOGEN AND THROMBIN SPONGE IN THE WOUND AREA. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2016; 29:236-239. [PMID: 28076477 PMCID: PMC5225862 DOI: 10.1590/0102-6720201600040006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/30/2016] [Indexed: 01/13/2023]
Abstract
Background Surgical strategy to increase the number of liver transplants in the pediatric population is the ex-situ liver transection (reduction or split). However, it is associated with complications such as hemorrhage and leaks. The human fibrinogen and thrombin sponge is useful for improving hemostasis in liver surgery. Aim Compare pediatric liver transplants with ex-situ liver transection (reduction or split) with or without the human fibrinogen and thrombin sponge. Methods Was performed a prospective analysis of 21 patients submitted to liver transplantation with ex-situ liver transection with the application of the human fibrinogen and thrombin sponge in the wound area (group A) and retrospective analysis of 59 patients without the sponge (group B). Results The characteristics of recipients and donors were similar. There were fewer reoperations due to bleeding in the wound area in group A (14.2%) compared to group B (41.7%, p=0.029). There was no difference in relation to the biliary leak (group A: 17.6%, group B: 5.1%, p=0.14). Conclusion There was a lower number of reoperations due to bleeding of the wound area of the hepatic graft when the human fibrinogen and thrombin sponge were used.
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Affiliation(s)
- Fernando Pompeu Piza Vicentine
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Adriano Miziara Gonzalez
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | | | - Barbara Burza Benini
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Marcelo Moura Linhares
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Gaspar de Jesus Lopes-Filho
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Jose Luiz Martins
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Alcides Augusto Salzedas-Netto
- Department of Surgical Gastroenterology and Liver Transplantation
- Postgraduation in Interdisciplinary Surgical Science, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil
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9
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Park KM, Hussein KH, Ghim JH, Ahn C, Cha SH, Lee GS, Hong SH, Yang S, Woo HM. Hepatic differentiation of porcine embryonic stem cells for translational research of hepatocyte transplantation. Transplant Proc 2015; 47:775-9. [PMID: 25891729 DOI: 10.1016/j.transproceed.2015.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/02/2015] [Accepted: 01/28/2015] [Indexed: 12/28/2022]
Abstract
Porcine embryonic stem cells (ES) are considered attractive preclinical research tools for human liver diseases. Although several studies previously reported generation of porcine ES, none of these studies has described hepatic differentiation from porcine ES. The aim of this study was to generate hepatocytes from porcine ES and analyze their characteristics. We optimized conditions for definitive endoderm induction and developed a 4-step hepatic differentiation protocol. A brief serum-free condition with activin A efficiently induced definitive endoderm differentiation from porcine ES. The porcine ES-derived hepatocyte-like cells highly expressed hepatic markers including albumin and α-fetoprotein, and displayed liver characteristics such as glycogen storage, lipid production, and low-density lipoprotein uptake. For the first time, we describe a highly efficient protocol for hepatic differentiation from porcine ES. Our findings provide valuable information for translational liver research using porcine models, including hepatic regeneration and transplant studies, drug screening, and toxicology.
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Affiliation(s)
- K M Park
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - K H Hussein
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea
| | - J H Ghim
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - C Ahn
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Biomedical Science, Kangwon National University, Chuncheon, Korea
| | - S H Cha
- Animal, Plant and Fisheries Quarantine and Inspection Agency, Anyang, Korea
| | - G S Lee
- College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
| | - S H Hong
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Medicine, Kangwon National University, Chuncheon, Korea
| | - S Yang
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Medicine, Kangwon National University, Chuncheon, Korea
| | - H M Woo
- Stem Cell Institute, Kangwon National University, Chuncheon, Korea; College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea.
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Abstract
OBJECTIVES To estimate the organ donation potential of patients dying at a children's hospital. DESIGN Retrospective cohort study. SETTING A free-standing, 271-bed, tertiary Children's Hospital with a pediatric trauma center. PATIENTS Patients dying in any ICU during 2011-2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 224 deaths, 23 (10%) met neurologic criteria for death: 18 donated organs (conversion rate 78%), 47 (19%) died without prior limitation of life-sustaining therapies, and the remaining 69% had withdrawal of life-sustaining therapies. Among those dying after withdrawal of life-sustaining therapies (n = 154), the organ procurement organization was not notified prior to death in 24%, and older patients were more likely to be referred compared to those less than 1 year old. Infection, cancer, and organ dysfunction were the most frequent conditions that disqualified dying patients from suitability for donation. Just over half of children more than 1 year old were suitable for donation after withdrawal of life-sustaining therapies compared to a fifth of infants (19%). Of 45 suitable for donation, 37 (82%) died within 1 hour. None of 7 infants younger than 1 month old died within 20 minutes, compared with 46% of infants between 1 month and 1 year (n = 6) and 72% of older children. Thirty-three families (73%) did not permit donation after circulatory criteria for death whereas 12 (27%) gave permission for donation, and all 12 were actual donors (conversion rate 12/37 [32%]). CONCLUSIONS The number of pediatric potential candidates for donation after circulatory determination of death was significantly larger than potential candidates for donation after neurologic determination of death at our hospital, but the actual donation rate was significantly lower. Increasing acceptance of donation after circulatory determination of death could increase organ donation. Among all children having withdrawal of life-sustaining therapies, donation after circulatory determination of death potential is less for infants.
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Dalal AR. Split liver transplantation: What’s unique? World J Transplant 2015; 5:89-94. [PMID: 26421261 PMCID: PMC4580931 DOI: 10.5500/wjt.v5.i3.89] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 12/26/2014] [Accepted: 06/19/2015] [Indexed: 02/05/2023] Open
Abstract
The intraoperative management of split liver transplantation (SLT) has some unique features as compared to routine whole liver transplantations. Only the liver has this special ability to regenerate that confers benefits in survival and quality of life for two instead of one by splitting livers. Primary graft dysfunction may result from small for size syndrome. Graft weight to recipient body weight ratio is significant for both trisegmental and hemiliver grafts. Intraoperative surgical techniques aim to reduce portal hyperperfusion and decrease venous portal pressure. Ischemic preconditioning can be instituted to protect against ischemic reperfusion injury which impacts graft regeneration. Advancement of the technique of SLT is essential as use of split cadaveric grafts expands the donor pool and potentially has an excellent future.
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