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Split liver transplantation. Transplant Proc 2006 Mar;38(2):602-3

Date

03/22/2006

Pubmed ID

16549186

DOI

10.1016/j.transproceed.2005.12.064

Scopus ID

2-s2.0-33645057950   21 Citations

Abstract

Seventy-five thousand Americans develop organ failure each year. Fifteen percent of those on the list for transplantation die while waiting. Several possible mechanisms to expand the organ pool are being pursued including the use of extended criteria donors, living donation, and split deceased donor transplants. Cadaveric organ splitting results from improved understanding of the surgical anatomy of the liver derived from Couinaud. Early efforts focused on reduced-liver transplantation (RLT) reported by both Bismuth and Broelsch in the mid-1980s. These techniques were soon modified to create both a left lateral segment graft appropriate for a pediatric recipient and a right trisegment for an appropriately sized adult. Techniques of split liver transplantation (SLT) were also modified to create living donor liver transplantation. Pichlmayr and Bismuth reported successful split liver transplantation in 1989 and Emond reported a larger series of nine split procedures in 1990. Broelsch and Busuttil described a technical modification in which the split was performed in situ at the donor institution with surgical division completed in the heart beating cadaveric donor. In situ splitting reduces cold ischemia, simplifies identification of biliary and vascular structures, and reduces reperfusion hemorrhage. However, in situ splits require specialized skills, prolonged operating room time, and increased logistical coordination at the donor institution. At UCLA over 120 in situ splits have been performed and this technique is the default when an optimal donor is available. Split liver transplantation now accounts for 10% of adult transplantations at UCLA and 40% of pediatric transplantations.

Author List

Yersiz H, Cameron AM, Carmody I, Zimmerman MA, Kelly BS Jr, Ghobrial RM, Farmer DG, Busuttil RW

Author

Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Bile Ducts
Cadaver
Child
Hepatectomy
Hepatic Veins
Humans
Liver
Liver Transplantation
Portal Vein
Tissue Donors
Tissue and Organ Harvesting
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0