Surgical Experience in Splitting Donor Liver into Left Lateral and Right Extended Lobes

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2005 Jul 15

PMID 16015693

Authors

Ji-Qi Yan

Thomas Becker

Michael Neipp

Cheng-Hong Peng

Rainer Lueck

Frank Lehner

Hong-Wei Li

Juergen Klempnauer

Affiliations

Soon will be listed here.

Abstract

Aim: To outline the surgical experience with donor liver splitting in split liver transplantation.

Methods: From March 1 to September 1 in 2004, 10 donor livers were split ex situ into a left lateral lobe (segments II and III) and a right extended lobe (segments I, IV-VIII) in Medical School of Hannover, and thereafter split liver transplantation was performed successfully in 19 cases. The average age, weight and ICU staying period of the donors were 32.7 years (15-51 years), 64.5 kg (45-75 kg) and 2.4 d (1-8 d) respectively.

Results: The average weight of the whole graft and the left lateral lobe was 1,322.6 g (956-1,665 g) and 281.8 g (198-373 g) respectively, and the average ratio of left lateral lobe to the whole graft was 0.215 (0.178-0.274). The average graft to recipient weight ratio (GRWR) of the left lateral lobe and the right extended lobe reached 2.44% (1.22-5.41%) and 1.73% (1.31-2.30%) respectively. On average it took approximately 105 min (85-135 min) to split the donor liver. Five donor organs showed anatomic variation including the left hepatic vein variation in two cases, the left hepatic artery variation in two cases and the bile duct variation in one case.

Conclusion: Split liver transplantation has become a mature surgical technique to expand the donor pool with promising results. In the process of graft splitting, close attention needs to be paid to potential anatomic variations, especially to variations of the left hepatic vein, the left hepatic artery, and the bile duct.

References

Emond J, Freeman Jr R, Renz J, Yersiz H, Rogiers X, Busuttil R . Optimizing the use of donated cadaver livers: analysis and policy development to increase the application of split-liver transplantation. Liver Transpl. 2002; 8(10):863-72. DOI: 10.1053/jlts.2002.34639. View

Renz J, Yersiz H, Reichert P, Hisatake G, Farmer D, Emond J . Split-liver transplantation: a review. Am J Transplant. 2003; 3(11):1323-35. DOI: 10.1046/j.1600-6135.2003.00254.x. View

Renz J, Emond J, Yersiz H, Ascher N, Busuttil R . Split-liver transplantation in the United States: outcomes of a national survey. Ann Surg. 2004; 239(2):172-81. PMC: 1356209. DOI: 10.1097/01.sla.0000109150.89438.bd. View

Yersiz H, Renz J, Hisatake G, Reichert P, Feduska Jr N, Lerner S . Technical and logistical considerations of in situ split-liver transplantation for two adults: Part II. Creation of left segment I-IV and right segment V-VIII grafts. Liver Transpl. 2002; 8(1):78-81. DOI: 10.1053/jlts.2002.31036. View

Atri M, Bret P . Intrahepatic portal venous variations: prevalence with US. Radiology. 1992; 184(1):157-8. DOI: 10.1148/radiology.184.1.1609075. View

Moreno A, Meneu J, Moreno E, Garcia I, Loinaz C, Jimenez C . Results in split liver transplantation. Transplant Proc. 2003; 35(5):1810-1. DOI: 10.1016/s0041-1345(03)00597-9. View

Kawarada Y, Das B, Taoka H . Anatomy of the hepatic hilar area: the plate system. J Hepatobiliary Pancreat Surg. 2001; 7(6):580-6. DOI: 10.1007/s005340070007. View

Ghobrial R, Yersiz H, Farmer D, Amersi F, Goss J, Chen P . Predictors of survival after In vivo split liver transplantation: analysis of 110 consecutive patients. Ann Surg. 2000; 232(3):312-23. PMC: 1421145. DOI: 10.1097/00000658-200009000-00003. View

Otte J, De Ville De Goyet J, Sokal E, Alberti D, Moulin D, de Hemptinne B . Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organs in pediatric liver transplantation. Ann Surg. 1990; 211(2):146-57. PMC: 1357958. DOI: 10.1097/00000658-199002000-00006. View

10.

Klempnauer J, Schrem H, Becker T, Nashan B, Luck R . Liver transplantation today. Transplant Proc. 2001; 33(7-8):3433-5. DOI: 10.1016/s0041-1345(01)02480-0. View

11.

Hardy K, Jones R . Hepatic artery anatomy in relation to reconstruction in liver transplantation: some unusual variations. Aust N Z J Surg. 1994; 64(6):437-40. DOI: 10.1111/j.1445-2197.1994.tb02248.x. View

12.

Deshpande R, Bowles M, Vilca-Melendez H, Srinivasan P, Girlanda R, Dhawan A . Results of split liver transplantation in children. Ann Surg. 2002; 236(2):248-53. PMC: 1422572. DOI: 10.1097/00000658-200208000-00014. View

13.

Hiatt J, Gabbay J, Busuttil R . Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994; 220(1):50-2. PMC: 1234286. DOI: 10.1097/00000658-199407000-00008. View

14.

Marcos A . Split-liver transplantation for adult recipients. Liver Transpl. 2000; 6(6):707-9. DOI: 10.1053/jlts.2000.19028. View

15.

Broelsch C, Emond J, Thistlethwaite J, Whitington P, Zucker A, Baker A . Liver transplantation, including the concept of reduced-size liver transplants in children. Ann Surg. 1988; 208(4):410-20. PMC: 1493747. DOI: 10.1097/00000658-198810000-00003. View

16.

Gridelli B, Spada M, Petz W, Bertani A, Lucianetti A, Colledan M . Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease. Transplantation. 2003; 75(8):1197-203. DOI: 10.1097/01.TP.0000061940.96949.A1. View

17.

Noujaim H, Mirza D, Mayer D, de Ville de Goyet J . Hepatic vein reconstruction in ex situ split-liver transplantation. Transplantation. 2002; 74(7):1018-21. DOI: 10.1097/00007890-200210150-00021. View

18.

Broelsch C, Emond J, Whitington P, Thistlethwaite J, Baker A, Lichtor J . Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg. 1990; 212(3):368-75; discussion 375-7. PMC: 1358174. DOI: 10.1097/00000658-199009000-00015. View

19.

Yersiz H, Renz J, Hisatake G, Reichert P, Feduska Jr N, Lerner S . Technical and logistical considerations of in situ split-liver transplantation for two adults: Part I. Creation of left segment II, III, IV and right segment I, V-VIII grafts. Liver Transpl. 2001; 7(12):1077-80. DOI: 10.1053/jlts.2001.30384. View

20.

Bismuth H, Houssin D . Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery. 1984; 95(3):367-70. View