Reuters Health Information (2011-10-05): Survival outcomes good for split liver transplants
Survival outcomes good for split liver transplants
Last Updated: 2011-10-05 17:58:15 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Split liver transplantation results in "excellent" patient and graft survival for both pediatric and adult patients, according to the authors of a new single-center review.
While postoperative morbidity was high, "this is justifiable owing to limited resources," said Dr. Parsia A. Vagefi of the University of California, San Francisco and his colleagues in the September Archives of Surgery.
They note that in these cases the liver -- part of which goes to an adult and part to a child -- can either be split ex vivo or in situ. (One of the advantages of splitting the liver in situ is the shorter cold ischemia time.) The left lateral segment goes to the child, and a right trisegment graft goes to the adult -- and the two recipients of a split liver don't necessarily need to be at the same transplant center.
While split liver transplantation has been used for decades, it still has not gained wide acceptance, according to Dr. Vagefi and his team. Just 3% of donor livers are split.
The researchers looked back at 106 patients who received a split liver graft at their center between 1993 and 2010.
They said the UCSF donor teams perform the ex vivo procedure exclusively, but 27 patients in the study received grafts that had been split in situ by teams from other transplant centers and shipped to UCSF.
Among the 63 adult recipients, one-, five-, and 10-year patient survival rates were 93%, 77%, and 73%. Graft survival rates at those intervals were 89%, 76%, and 65%, respectively.
There were no significant differences in patient or graft survival with splits done ex vivo or in situ.
In the 43 children, one-, five-, and 10-year patient survival rates were 84%, 75%, and 69%. Graft survival was 77%, 63%, and 57%. Again, ex vivo and in situ split grafts yielded similar patient and graft survival rates.
Twenty-nine percent of adult recipients developed biliary complications, while 11% had vascular problems, and 11% required unplanned exploratory surgery. Eight percent developed incisional hernias, while one patient each had small for size syndrome, required a shunt when the transplant was performed, or had primary nonfunction of the donor organ.
In the pediatric patients, there was one case of primary nonfunction, while 40% of patients developed biliary complications and 26% had vascular complications.
"We recognize that there is a higher risk associated with split liver transplantation in terms of potential complications, and we inform our patients that it's a decision they have to make," Dr. Vagefi told Reuters Health. "If they're willing to assume that extra risk with the hope of getting transplanted earlier, these are the patients who choose to consent for split liver transplant."
The current findings can't show whether ex vivo or in situ splitting is best, Dr. Vagefi said in an interview. "Whichever technique people become comfortable with being able to apply, that is only going to be able to help more recipients in the end."
Dr. Johnny C. Hong, director of the Living Donor Transplantation Program at the David Geffen School of Medicine at UCLA and author of an editorial published with the study, told Reuters Health that in order to expand the use of split liver transplantation, it will be necessary to train more surgeons to do it, and identify a learning curve for the procedure.
"It's a technically very highly demanding procedure," he said. "You don't want people to start doing this Rambo-style. It would cost people's lives and waste organs."
Arch Surg 2011.