Abstract
The first reports on split liver transplantation in the early 1980s gave rise to great expectations because it became clear that splitting a graft for two recipients was technically feasible [1, 2]. As a consequence, the shortage of donors for pediatric patients could be alleviated without detrimental effects on the pool for adult recipients [3]. Therefore, one should expect that a technique which increases the number of grafts for transplantation and thereby reduces waiting list time and mortality, especially in the field of pediatric transplantation, should have become a popular method of transplantation. However, the percentage of split liver transplantations of the total number of performed transplantations hardly increased in the following years. When analyzing data from the UNOS registry, split liver transplantation made up only about 5% of all performed pediatric liver transplantations in 1996 [4]. In 1999, data of Eurotransplant International and of the European Liver Transplant Registry showed that split liver transplantation made up between 4 and 9% of all performed liver transplantations [5, 6]. It is obvious that despite the practical and theoretical advantages of splitting livers, there seems still to be some restraint for using this technique in the majority of liver transplant centers. However, split liver transplantation is not only a necessity but it also deserves broader application because the results can be improved if certain precautions are taken. By analyzing a single center’s experience, this chapter aims at indicating some crucial factors for a successful split liver program.
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Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H (1988) Transplantation einer Spenderleber auf zwei Empfänger (Splitting-Transplantation): Eine neue Methode in der Weiterentwicklung der Lebersegmenttransplantation. Langenbecks Arch Chir 373:127–130
Emond JC, Whitington PF, Thistlethwaite JR, et al. (1990) Transplantation of two patients with one liver. Analysis of a preliminary experience with’ split-liver’ grafting. Ann Surg 212:14–22
Slooff MJ (1995) Reduced size liver transplantation, split liver transplantation, and living related liver transplantation in relation to the donor organ shortage. Transpl Int 8:65–68
Sindhi R, Rosendale J, Mundy D, et al. (1999) Impact of segmental grafts on pediatric liver transplantation — a review of the United Network for Organ Sharing Scientific Registry data (1990–1996). J Pediatr Surg 34:107–110
Persijn G (2000) Eurotransplant International Foundation. Personal communication
Adam R, Bismuth H, Castaing D, Bustany P, Karam V, Cailliez V (1999) Registry of the European Liver Transplant Association; Data Analysis 05/1968-12/1997. Hpital Paul Brousse Villejuf, France
Broelsch CE, Emond JC, Whitington PF, Thistlethwaite JR, Baker AL, Lichtor JL (1990) Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg 212:368–375
Shaw BW Jr, Wood RP, Stratta RJ, et al. (1990) Management of arterial anomalies encountered in split-liver transplantation. Transplant Proc 22:420–422
Rogiers X, Malago M, Gawad K, et al. (1996) In situ splitting of cadaveric livers: the ultimate expansion of a limited donor pool. Ann Surg 224:331–339
De Ville de Goyet J, Hausleithner V, Reding R, Lerut J, Janssen M, Otte JB (1993) Impact of innovative techniques on the waiting list and results in pediatric liver transplantation. Transplantation 56:1130–1136
Sieders E, Peeters PM, TenVergert EM, et al. (1999) Analysis of survival and morbidity after pediatric liver transplantation with full-size and technical-variant grafts. Transplantation 68:540–545
Strasberg SM, Lowell JA, Howard TK (1999) Reducing the shortage of donor livers: what would it take to reliably split livers for transplantation into two adult recipients? Liver Transpl Surg 5:437–450
Shaw BW Jr, Wood RP, Stratta RJ, et al. (1990) Management of arterial anomalies encountered in split-liver transplantation. Transplant Proc 22:420–422
Houssin D, Boillot O, Soubrane O, et al. (1993) Controlled liver splitting for transplantation in two recipients: technique, results and perspectives. Br J Surg 80:75–80
De Ville de Goyet J (1995) Split liver transplantation in Europe — 1988 to 1993. Transplantation 59:1371–1376
Azoulay D, Astarcioglu I, Bismuth H, et al. (1996) Split-liver transplantation. The Paul Brousse policy. Ann Surg 224:737–746
Kalayoglu M, D’Alessandro AM, Knechtle SJ, et al. (1996) Preliminary experience with split liver transplantation. J Am Coll Surg 182:381–387
Rela M, Vougas V, Muiesan P, et al. (1998) Split liver transplantation: King’s College Hospital experience. Ann Surg 227:282–288
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© 2002 Springer-Verlag Berlin Heidelberg
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Slooff, M.J.H. (2002). The paradigm of split liver transplantation: a word of caution. In: Rogiers, X., Bismuth, H., Busuttil, R.W., Broering, D.C., Azoulay, D. (eds) Split liver transplantation. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57523-5_17
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DOI: https://doi.org/10.1007/978-3-642-57523-5_17
Publisher Name: Steinkopff, Heidelberg
Print ISBN: 978-3-7985-1256-6
Online ISBN: 978-3-642-57523-5
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