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Muhammad I, Rehman FUL, Wang F, Xiong X, Lianghao Z, Jinzhen C. Application Effectiveness of Segment IV Portal Vein Reconstruction for Early Postoperative Liver Function Recovery in Split Liver Transplantation. Transpl Int 2023; 36:10808. [PMID: 37181788 PMCID: PMC10169602 DOI: 10.3389/ti.2023.10808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/06/2023] [Indexed: 05/16/2023]
Abstract
The objective of this study was to investigate the significance of portal vein reconstruction in segment IV of the liver on early postoperative liver function recovery in split liver transplantation. The clinical data of patients of right trilobe split liver transplantation in our center were analyzed and divided into two groups, including a group without portal vein reconstruction and a group with portal vein reconstruction. Clinical data of alanine aminotransferase (ALT), aspartate transaminase (AST), albumin (ALB), creatinine (Cr), total bilirubin (TB), alkaline phosphatase (ALP), gamma-glutamyl Transferase (GGT), lactic acid (Lac), and international normalized ratio (INR) levels were analyzed. The technique of segment IV portal vein reconstruction is beneficial to the early postoperative recovery of liver function. Statistically, there was no significant effect of portal vein reconstruction in the IV segment of the liver on the recovery of liver function within 1 week after split liver transplantation. There was no significant difference in survival rate between the control group and reconstruction group over the 6 months follow-up period after surgery.
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Affiliation(s)
- Imran Muhammad
- Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Faisal U. L. Rehman
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Feng Wang
- Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaopeng Xiong
- Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhang Lianghao
- Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cai Jinzhen
- Organ Transplantation Center, The Affiliated Hospital of Qingdao University, Qingdao, China
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Chan KM, Hung HC, Lee JC, Wu TH, Wang YC, Cheng CH, Lee CF, Wu TJ, Chou HS, Lee WC. A review of split liver transplantation with full right/left hemi-liver grafts for 2 adult recipients. Medicine (Baltimore) 2021; 100:e27369. [PMID: 34596151 PMCID: PMC8483827 DOI: 10.1097/md.0000000000027369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Liver transplantation has become a routine operation in many transplantation centers worldwide. However, liver graft availability fails to meet patient demands. Split liver transplantation (SPLT), which divides a deceased donor liver into 2 partial liver grafts, is a promising strategy for increasing graft availability for transplantation and ameliorating organ shortage to a certain degree. However, the transplantation community has not yet reached a consensus on SPLT because of the variable results. Specifically, SPLT for 2 adult recipients using full right/left hemi-liver grafts is clinically more challenging in terms of surgical technique and potential postoperative complications. Therefore, this review summarizes the current status of SPLT, focusing on the transplantation of adult recipients. Furthermore, the initiation of the SPLT program, donor allocation, surgical aspects, recipient outcomes, and obstacles to developing this procedure will be thoroughly discussed. This information might help provide an optimal strategy for implementing SPLT for 2 adult recipients among current transplantation societies. Meanwhile, potential obstacles to SPLT might be overcome in the near future with growing knowledge, experience, and refinement of surgical techniques. Ultimately, the widespread diffusion of SPLT may increase graft availability and mitigate organ donation shortages.
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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: 20] [Impact Index Per Article: 5.0] [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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Spaggiari M, Mashbari H, Di Bella C, Benedetti E, Tzvetanov I. Portojejunostomy in Split Liver Transplantation as a Rescue Technique for Challenging Biliary Reconstruction: A Case Report. Transplant Proc 2019; 51:575-578. [PMID: 30879593 DOI: 10.1016/j.transproceed.2018.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 11/29/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
Abstract
Cadaveric split liver transplantation (SLT) is a valid option to increase the pool of cadaveric organs, obtaining 2 functioning grafts from a single donor. Typically, SLT is performed for 1 adult and 1 pediatric recipient. However, on the heels of great results achieved in living donor liver transplantation, splitting cadaveric liver into full right graft and full left graft for 2 adults has become a feasible idea. The rate of biliary complications remains the "Achilles heel" in partial graft liver transplantation, either from cadaveric or living donors. In cases of biliary complications, interventional radiology and/or endoscopic procedures are the cornerstone of management. Surgical revision is left as the last option. When surgical revision fails, retransplantation becomes the only rescue option. Herein we describe the case of a cadaveric SLT, complicated by biliary leakage in the presence of multiple bile ducts. A duct-to-duct anastomosis was not feasible. Therefore, a hepaticojejunostomy was performed and resulted in a high-output biliary leak from different sources. Given the anatomy of the biliary tree, radiologic interventional measures were not feasible to address the leak. The idea of performing a portoenterostomy to restore bilioenteric continuity proved to be successful. Portoenterostomy should not be performed in lieu of other alternatives, but rather as the last option to avoid retransplantation in cases of complicated biliary reconstruction after partial graft liver transplant.
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Affiliation(s)
- M Spaggiari
- Division of Transplantation, General Surgery Department, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - H Mashbari
- Division of Transplantation, General Surgery Department, University of Illinois at Chicago, Chicago, Illinois, USA
| | - C Di Bella
- Division of Transplantation, General Surgery Department, University of Illinois at Chicago, Chicago, Illinois, USA
| | - E Benedetti
- Division of Transplantation, General Surgery Department, University of Illinois at Chicago, Chicago, Illinois, USA
| | - I Tzvetanov
- Division of Transplantation, General Surgery Department, University of Illinois at Chicago, Chicago, Illinois, USA
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Hackl C, Schmidt KM, Süsal C, Döhler B, Zidek M, Schlitt HJ. Split liver transplantation: Current developments. World J Gastroenterol 2018; 24:5312-5321. [PMID: 30598576 PMCID: PMC6305537 DOI: 10.3748/wjg.v24.i47.5312] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/09/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
In 1988, Rudolf Pichlmayr pioneered split liver transplantation (SLT), enabling the transplantation of one donor liver into two recipients - one pediatric and one adult patient. In the same year, Henri Bismuth and colleagues performed the first full right/full left split procedure with two adult recipients. Both splitting techniques were rapidly adopted within the transplant community. However, a SLT is technically demanding, may cause increased perioperative complications, and may potentially transform an excellent deceased donor organ into two marginal quality grafts. Thus, crucial evaluation of donor organs suitable for splitting and careful screening of potential SLT recipients is warranted. Furthermore, the logistic background of the splitting procedure as well as the organ allocation policy must be adapted to further increase the number and the safety of SLT. Under defined circumstances, in selected patients and at experienced transplant centers, SLT outcomes can be similar to those obtained in full organ LT. Thus, SLT is an important tool to reduce the donor organ shortage and waitlist mortality, especially for pediatric patients and small adults. The present review gives an overview of technical aspects, current developments, and clinical outcomes of SLT.
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Affiliation(s)
- Christina Hackl
- Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
| | - Katharina M Schmidt
- Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
| | - Caner Süsal
- Collaborative Transplant Study (CTS), Institute of Immunology, Heidelberg University, Heidelberg 69120, Germany
| | - Bernd Döhler
- Collaborative Transplant Study (CTS), Institute of Immunology, Heidelberg University, Heidelberg 69120, Germany
| | - Martin Zidek
- Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
| | - Hans J Schlitt
- Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
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6
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Badawy A, Kaido T, Uemoto S. Current Status of Liver Transplantation Using Marginal Grafts. J INVEST SURG 2018; 33:553-564. [PMID: 30457408 DOI: 10.1080/08941939.2018.1517197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Amr Badawy
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of General Surgery, Alexandria University, Alexandria, Egypt
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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7
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Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21 st century. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:409. [PMID: 30498736 PMCID: PMC6230860 DOI: 10.21037/atm.2018.09.68] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/29/2018] [Indexed: 12/20/2022]
Abstract
Solid organ transplantation (SOT) has emerged from an experimental approach in the 20th century to now being an established and practical definitive treatment option for patients with end-organ dysfunction. The evolution of SOT has seen the field progress rapidly over the past few decades with incorporation of a variety of solid organs-liver, kidney, pancreas, heart, and lung-into the donor pool. New advancements in surgical technique have allowed for more efficient and refined multi-organ procurements with minimal complications and decreased ischemic injury events. Additionally, immunosuppression therapy has also seen advancements with the expansion of immunosuppressive protocols to dampen the host immune response and improve short and long-term graft survival. However, the field of SOT faces new barriers, most importantly the expanding demand for SOT that is outpacing the current supply. Allocation protocols have been developed in an attempt to address these concerns. Other avenues for SOT are also being explored to increase the donor pool, including split-liver donor transplants, islet cell implantation for pancreas transplants, and xenotransplantation. The future of SOT is bright with exciting new research being explored to overcome current obstacles.
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Affiliation(s)
- Cara K. Black
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Oswaldo Aguirre
- MedStar Georgetown University Hospital, MedStar Georgetown Transplant Institute, Washington, DC, USA
| | - Jason S. Hawksworth
- MedStar Georgetown University Hospital, MedStar Georgetown Transplant Institute, Washington, DC, USA
| | - Michael Sosin
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
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8
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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: 1.7] [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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9
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Elnaggar AS, Guarrera JV. The Marginal Liver Donor and Organ Preservation Strategies. LIVER ANESTHESIOLOGY AND CRITICAL CARE MEDICINE 2018:207-220. [DOI: 10.1007/978-3-319-64298-7_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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10
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Ross MW, Cescon M, Angelico R, Andorno E, Rossi G, Pinna A, De Carlis L, Baccarani U, Cillo U, Colledan M, Mazzaferro V, Tisone G, Rossi M, Tuzzolino F, Pagano D, Gruttadauria S, Mazariegos G, Gridelli B, Spada M. A matched pair analysis of multicenter longterm follow-up after split-liver transplantation with extended right grafts. Liver Transpl 2017; 23:1384-1395. [PMID: 28650108 DOI: 10.1002/lt.24808] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/29/2017] [Accepted: 06/18/2017] [Indexed: 12/13/2022]
Abstract
Split-liver transplantation has been proposed as an alternative to whole liver (WL) transplantation to expand the donor pool, but studies comparing adult longterm outcomes between the 2 methods are conflicting and limited. This is the first Italian multicenter study that retrospectively analyzed 119 matched-pair recipients of whole and extended right grafts (ERGs) for longterm survival outcomes. In the overall population, WL recipients showed higher patient survival at 1 (93% versus 73%), 5 (87% versus 65%), and 10 years (83% versus 60%) after transplantation compared with split-liver recipients (P < 0.001); graft survivals of WL recipients were also superior at 1 (90% versus 76%), 5 (84% versus 57%), and 10 years (81% versus 52%) posttransplant (P < 0.001). However, among the 81 matched pairs that survived the first posttransplant year, 5- and 10-year patient survivals were 90% and 81% for split recipients and 99% and 96% for whole recipients, respectively (P = 0.34). The 5- and 10-year graft survivals were also comparable: 87% and 77% for split recipients, and 86% and 82% for whole recipients (P = 0.86). Cox regression analysis identified donor age >50, donor-to-recipient weight ratio < 1, retransplantation status, and United Network for Organ Sharing I-IIA status as risk factors for partial graft use. There were no significant differences in 5-year outcomes based on center volume. In conclusion, we demonstrate that adult liver transplantation with ERGs can achieve longterm success comparable with that of whole grafts in appropriate patients but should be selectively used in patients with risk factors. Liver Transplantation 23 1384-1395 2017 AASLD.
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Affiliation(s)
- Michael W Ross
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Roberta Angelico
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù, Children's Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Enzo Andorno
- Department of Transplant Surgery, San Martino Hospital, University of Genoa, Genoa, Italy
| | - Giorgio Rossi
- Division of Liver Transplantation, Ca' Granda Maggiore Hospital, Milan, Italy
| | - Antonio Pinna
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luciano De Carlis
- Department of Multi-Disciplinary Surgery, Division of General, HBP and Transplantation Surgery, Niguarda Transplant Center, Niguarda Hospital, Milano-Bicocca University, Milan, Italy
| | - Umberto Baccarani
- Division of Liver Transplant, Department of Medical and Biological Sciences, University Hospital of Udine, Udine, Italy
| | - Umberto Cillo
- Division of Hepatobiliary Surgery and Liver Transplantation, University of Padua, Padua, Italy
| | - Michele Colledan
- Division of Liver and Small Bowel Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Vincenzo Mazzaferro
- Division of Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori of Milano, Istituto di Ricovero e Cura a Carattere Scientifico Foundation, University of Milan, Milan, Italy
| | - Giuseppe Tisone
- Division of Organ Transplantation, Tor Vergata University, Rome, Italy
| | - Massimo Rossi
- Department of General Surgery and Organ Transplantation, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Fabio Tuzzolino
- Information Technology Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy
| | - Duilio Pagano
- Department for the Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy
| | - Salvatore Gruttadauria
- Department for the Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy
| | - George Mazariegos
- Division of Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Bruno Gridelli
- Department for the Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù, Children's Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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11
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Eberlein M, Reed RM, Chahla M, Bolukbas S, Blevins A, Van Raemdonck D, Stanzi A, Inci I, Marasco S, Shigemura N, Aigner C, Deuse T. Lobar lung transplantation from deceased donors: A systematic review. World J Transplant 2017; 7:70-80. [PMID: 28280698 PMCID: PMC5324031 DOI: 10.5500/wjt.v7.i1.70] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/12/2016] [Accepted: 12/28/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To systematically review reports on deceased-donor-lobar lung transplantation (ddLLTx) and uniformly describe size matching using the donor-to-recipient predicted-total lung-capacity (pTLC) ratio.
METHODS We set out to systematically review reports on ddLLTx and uniformly describe size matching using the donor-to-recipient pTLC ratio and to summarize reported one-year survival data of ddLLTx and conventional-LTx. We searched in PubMed, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley (CDSR), Database of Abstracts of Reviews of Effects via Wiley (DARE), Cochrane Central Register of Controlled Trials via Wiley (CENTRAL), Scopus (which includes EMBASE abstracts), and Web of Science for original reports on ddLLTx.
RESULTS Nine observational cohort studies reporting on 301 ddLLTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The ddLLTx-group was often characterized by high acuity; however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pTLC ratio was available for 242 ddLLTx (80%). The mean pTLCratio before lobar resection was 1.25 ± 0.3 and the transplanted pTLCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddLLTx-group ranged from 50%-100%, compared to 72%-88% in the conventional-LTx group. In the largest study ddLLTx (n = 138) was associated with a lower one-year-survival compared to conventional-LTx (n = 539) (65.1% vs 84.1%, P < 0.001).
CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddLLTx could improve outcomes of this important surgical option.
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12
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Sakamoto S, Kasahara M, Ogura Y, Inomata Y, Uemoto S. Current status of deceased donor split liver transplantation in Japan. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:837-45. [DOI: 10.1002/jhbp.292] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/14/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Seisuke Sakamoto
- Department of Transplantation/Pediatric Surgery; Kumamoto University; 1-1-1 Honjo Chuo-ku Kumamoto 862-8556 Japan
- Transplantation Center; National Center for Child Health and Development; Tokyo Japan
| | - Mureo Kasahara
- Transplantation Center; National Center for Child Health and Development; Tokyo Japan
| | - Yasuhiro Ogura
- Department of Transplant Surgery; Nagoya University; Nagoya Japan
| | - Yukihiro Inomata
- Department of Transplantation/Pediatric Surgery; Kumamoto University; 1-1-1 Honjo Chuo-ku Kumamoto 862-8556 Japan
| | - Shinji Uemoto
- Department of Surgery; Kyoto University; Kyoto Japan
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13
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Affiliation(s)
- Young Rok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Seoul National University College of Medicine, Seoul, Korea
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14
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Schrem H, Kleine M, Lankisch TO, Kaltenborn A, Kousoulas L, Zachau L, Lehner F, Klempnauer J. Long-term results after adult ex situ split liver transplantation since its introduction in 1987. World J Surg 2015; 38:1795-806. [PMID: 24414197 PMCID: PMC7102172 DOI: 10.1007/s00268-013-2444-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Split liver transplantation is still discussed controversially. Utilization of split liver grafts has been declining since a change of allocation rules for the second graft abolished incentives for German centres to perform ex situ splits. We therefore analysed our long-term experiences with the first ex situ split liver transplant series worldwide. METHODS A total of 131 consecutive adult ex situ split liver transplants (01.12.1987-31.12.2010) were analysed retrospectively. RESULTS Thirty-day mortality rates and 1- and 3-year patient survival rates were 13, 76.3, and 66.4 %, respectively. One- and three-year graft survival rates were 63.4 and 54.2 %, respectively. The observed 10-year survival rate was 40.6 %. Continuous improvement of survival from era 1 to 3 was observed (each era: 8 years), indicating a learning curve over 24 years of experience. Patient and graft survival were not influenced by different combinations of transplanted segments or types of biliary reconstruction (p > 0.05; Cox regression). Patients transplanted for primary sclerosing cholangitis had better survival (p = 0.021; log-rank), whereas all other indications including acute liver failure (13.6 %), acute and chronic graft failure (9.1 %) had no significant influence on survival (p > 0.05; log-rank). Biliary complications (27.4 %) had no significant influence on patient or graft survival (p > 0.05; log-rank). Hepatic artery thrombosis (13.2 %) had a significant influence on graft survival but not on patient survival (p = 0.002, >0.05, respectively; log-rank). CONCLUSIONS Split liver transplantation can be used safely and appears to be an underutilized resource that may benefit from liberal allocation of the second graft.
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Affiliation(s)
- Harald Schrem
- Department of General, Visceral and Transplantation Surgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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15
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Maggi U, De Feo TM, Andorno E, Cillo U, De Carlis L, Colledan M, Burra P, De Fazio N, Rossi G. Fifteen years and 382 extended right grafts from in situ split livers in a multicenter study: Are these still extended criteria liver grafts? Liver Transpl 2015; 21:500-11. [PMID: 25545700 DOI: 10.1002/lt.24070] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/02/2014] [Accepted: 12/14/2014] [Indexed: 12/13/2022]
Abstract
In situ split liver extended right grafts (SL-ERGs) are still considered marginal grafts. Our aim was to verify this statement at the present time. From 1997 to 2011, a multicenter, retrospective study based on a prospective database was performed at 9 liver transplantation (LT) centers in northern Italy; it included 382 in situ SL-ERG transplants in adults. There were 358 primary LTs and 24 retransplantations (RETXs). The 1-, 3-, and 5-year overall graft survival rate for LT with in situ SL-ERGs were 73.5%, 63.3%, and 60.7%, respectively, from 1997 to 2004 and 83.5%, 80.3%, and 80.3%, respectively, thereafter (P=0.0001). A shorter total ischemia time and fewer RETX grafts were the main differences between the characteristics of the 2 periods. From 1997 to 2011, the 1-, 3-, and 5-year graft survival rates showed a significant difference between the 358 primary LT in situ SL-ERGs and the 24 RETX in situ SL-ERGs (P<0.001). In a multivariate analysis, the main prognostic factor for 60-day graft survival was a total ischemia time<8 hours for the 358 primary in situ SL-ERGs. From 2005 to 2011, in 2473 LTs, the 5-year graft survival for 184 in situ SL-ERGs and 2289 whole grafts was 75% and 80% (P=0.3), respectively. Univariate and multivariate studies alike failed to indicate that the type of graft was a prognostic factor for graft survival. A donor age>60 years, RETX grafts, and urgency were the main prognostic factors for failure for all of the grafts. Although caution should be taken regarding the choice of appropriate donors, in situ SL-ERGs should no longer be considered marginal grafts for experienced LT centers. SL-ERGs should not be used in RETX settings, and when SL-ERGs are used as primary grafts, the total ischemia time should be less than 8 hours.
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Affiliation(s)
- Umberto Maggi
- UO Chirurgia Generale e Trapianti di Fegato, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Digestive and Hepatobiliary Surgery, AP-HP, U.F.R. de Médecine de l'Université Paris XII-Créteil, Paris, France
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Sakamoto S, Uchida H, Hamano I, Shigeta T, Sasaki K, Kanazawa H, Fukuda A, Kasahara M. Impact of the current organ allocation system for deceased donor liver transplantation on the outcomes of pediatric recipients: a single center experience in Japan. Pediatr Surg Int 2013; 29:1109-14. [PMID: 23975020 DOI: 10.1007/s00383-013-3381-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim of this study was to analyze the outcomes of children added to the waiting list for deceased donor liver transplantation (DDLT) and the results of DDLT in a single Japanese center. METHODS Forty-seven children were listed on the organ allocation system for DDLT. The priority points related to the medical status of each patient were evaluated and stratified into four categories; 10, 8, 6, and 3 points. The clinical data were collected from the medical records, and the outcomes were analyzed. RESULTS There were 10 priority points in 25 patients, 6 points in 13 and 3 points in 9. Ten recipients (21.3 %); 7 patients with 10 points and 3 patients with 6 points, underwent DDLT. Seven out of the 10 recipients received split/reduced liver grafts. The surgical complications consisted of biliary stricture, hepatic venous outflow obstruction, intraabdominal abscess and intraabdominal bleeding. Two recipients, who were critically-ill before DDLT, died due to sepsis. The one-year graft survival rate was 70.0 %, with a median follow-up period of 6.4 months. CONCLUSION The initial experience with pediatric DDLT in our series was satisfactory. Split LT of deceased donor organs may have the potential to resolve the serious organ shortage in Japan.
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Affiliation(s)
- Seisuke Sakamoto
- Division of Transplant Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, 157-8535, Japan,
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Cauley RP, Vakili K, Fullington N, Potanos K, Graham DA, Finkelstein JA, Kim HB. Deceased-donor split-liver transplantation in adult recipients: is the learning curve over? J Am Coll Surg 2013; 217:672-684.e1. [PMID: 23978530 PMCID: PMC4876853 DOI: 10.1016/j.jamcollsurg.2013.06.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/05/2013] [Accepted: 06/05/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Infants have the highest wait-list mortality of all liver transplantation candidates. Deceased-donor split-liver transplantation, a technique that provides both an adult and pediatric graft, might be the best way to decrease this disproportionate mortality. Yet concern for an increased risk to adult split recipients has discouraged its widespread adoption. We aimed to determine the current risk of graft failure in adult recipients after split-liver transplantation. STUDY DESIGN United Network for Organ Sharing data from 62,190 first-time adult recipients of deceased-donor liver transplants (1995-2010) were analyzed (889 split grafts). Bivariate risk factors (p < 0.2) were included in Cox proportional hazards models of the effect of transplant type on graft failure. RESULTS Split-liver recipients had an overall hazard ratio of graft failure of 1.26 (p < 0.001) compared with whole-liver recipients. The split-liver hazard ratio was 1.45 (p < 0.001) in the pre-Model for End-Stage Liver Disease era (1995-2002) and 1.10 (p = 0.28) in the Model for End-Stage Liver Disease era (2002-2010). Interaction analyses suggested an increased risk of split-graft failure in status 1 recipients and those given an exception for hepatocellular carcinoma. Excluding higher-risk recipients, split and whole grafts had similar outcomes (hazard ratio = 0.94; p = 0.59). CONCLUSIONS The risk of graft failure is now similar between split and whole-liver recipients in the vast majority of cases, which demonstrates that the expansion of split-liver allocation might be possible without increasing the overall risk of long-term graft failure in adult recipients. Additional prospective analysis should examine if selection bias might account for the possible increase in risk for recipients with hepatocellular carcinoma or designated status 1.
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Affiliation(s)
- Ryan P. Cauley
- Department of Surgery, Boston Children’s Hospital, MA, USA
| | | | | | | | | | | | - Heung Bae Kim
- Department of Surgery, Boston Children’s Hospital, MA, USA
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Krishnan KR, Bhattacharya R, Pereira A, Otto AK, Carithers RL, Reyes JD, Perkins JD. The HALOS-ND model: a step in the journey of predicting hospital length of stay after liver transplantation. Clin Transplant 2013; 27:809-22. [DOI: 10.1111/ctr.12217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Arema Pereira
- Gastroenterology; University of Washington; Seattle WA USA
| | - Annie K. Otto
- Transplant Surgery; University of Washington; Seattle WA USA
| | | | - Jorge D. Reyes
- Transplant Surgery; University of Washington; Seattle WA USA
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Affiliation(s)
- Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA
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Freeman RB. Deceased donor risk factors influencing liver transplant outcome. Transpl Int 2013; 26:463-70. [PMID: 23414069 DOI: 10.1111/tri.12071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 11/27/2012] [Accepted: 01/07/2013] [Indexed: 12/14/2022]
Abstract
As the pressure for providing liver transplantation to more and more candidates increases, transplant programs have begun to consider deceased donor characteristics that were previously considered unacceptable. With this trend, attention has focused on better defining those donor factors that can impact the outcome of liver transplantation. This review examines deceased donor factors that have been associated with patient or graft survival as well as delayed graft function and other liver transplant results.
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Affiliation(s)
- Richard B Freeman
- Department of Surgery, Dartmouth Hitchcock Medical Center, Geisel School of Medicine a Dartmouth, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Spada M, Boggi U, Ricotta C, Pagano D, Gruttadauria S. Left Sectionectomy for Living Donor: Laparoscopic Approach. Updates Surg 2013. [DOI: 10.1007/978-88-470-2664-3_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Debbaut C, De Wilde D, Casteleyn C, Cornillie P, Van Loo D, Van Hoorebeke L, Monbaliu D, Fan YD, Segers P. Modeling the Impact of Partial Hepatectomy on the Hepatic Hemodynamics Using a Rat Model. IEEE Trans Biomed Eng 2012; 59:3293-3303. [DOI: 10.1109/tbme.2012.2199108] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Zhou J, Wang Z, Li L, Chen FL, Cui L, Xie HW, Hou WY, Zhang JS, Liu SL, Ming AX, Li SL, Wang HB. An experimental study of triple split-liver transplantation in dogs. Shijie Huaren Xiaohua Zazhi 2012; 20:2138-2145. [DOI: 10.11569/wcjd.v20.i23.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the feasibility of a strategy of tripartition of a whole deceased liver graft for use in 3 recipients in dogs to ultimately maximize donor organ use.
METHODS: Adult healthy mongrel dogs were selected to be donors (n = 30, weighing between 20-25 kg) and recipients (n = 30, weighing between 8-15 kg). Donor/recipient pairs were randomly matched. For donor operation, transection of the parenchymal bridge was performed between the right lateral lobe and right middle lobe, and between the left middle lobe and the quadrate lobe. After in vivo perfusion, the left, middle and right liver grafts were procured, and their primary branches were cut near the main stem. Among the three liver grafts, the one was chosen to be implanted if it's GRWR (graft-to-recipient weight ratio) was more than 1.0% and was nearest to 1.5%. Recipients entered Groups A, B and C if the left, middle and right grafts were chosen, respectively. With the piggyback technique, the outflow orifice of liver graft was anastomosed to the anterolateral wall of the recipient vena cava. The graft was revascularized via reconstructed hepatic vein and portal vein, and then the hepatic artery and bile duct were anastomosed both in an end-to-end manner. Biliary and abdominal drainage was inspected postoperatively. Autopsies were performed promptly after recipients' death to investigate the possibility of technical complications.
RESULTS: By prominent fissures, the canine liver was divided into 7 lobes, among which the parenchymal bridges were thin. The parenchymal bridge connecting the right lateral lobe to the right middle lobe was much thinner than that connecting the left middle lobe to the quadrate lobe. No major conduit was found during transection of these two parenchymal bridges. The portal vein was split into three branches. The common bile duct was formed by the union of three hepatic ducts-the left, middle and right hepatic ducts. The hepatic vein consisted of the left, median and right hepatic veins. Anatomical variations in the hepatic arteries could be found. Among three recipient groups, the operation time, anhepatic time and blood loss did not show significant differences (P > 0.05), but the mean recipient weight, liver graft weight, and GRWR differed significantly (all P < 0.01). In the three groups, none of the recipients died during surgery. Once the hepatic vein and the portal vein were anastomosed and declamped, the implanted liver regained its color soon and its appearance returned to normal following arterial revascularization. There was no statistical difference in survival duration among the three groups (128.3 h ± 48.5 h vs 102.7 h ± 59.8 h vs 98.7 h ± 46.8 h, P = 0.234). Ascites and liver necrosis were not found at autopsy. Bile was present in the bile duct and all anastomoses were patent.
CONCLUSION: Our experimental results indicate that the whole liver of a big dog can be split into three parts, every one of which can be transplanted to a small recipient as an independent allograft.
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Liu Q, Rehman H, Krishnasamy Y, Haque K, Schnellmann R, Lemasters J, Zhong Z. Amphiregulin stimulates liver regeneration after small-for-size mouse liver transplantation. Am J Transplant 2012; 12:2052-61. [PMID: 22694592 PMCID: PMC3409348 DOI: 10.1111/j.1600-6143.2012.04069.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study investigated whether amphiregulin (AR), a ligand of the epidermal growth factor receptor (EGFR), improves liver regeneration after small-for-size liver transplantation. Livers of male C57BL/6 mice were reduced to ~50% and ~30% of original sizes and transplanted. After transplantation, AR and AR mRNA increased in 50% but not in 30% grafts. 5-Bromodeoxyuridine (BrdU) labeling, proliferating cell nuclear antigen (PCNA) expression and mitotic index increased substantially in 50% but not 30% grafts. Hyperbilirubinemia and hypoalbuminemia occurred and survival decreased after transplantation of 30% but not 50% grafts. AR neutralizing antibody blunted regeneration in 50% grafts whereas AR injection (5 μg/mouse, iv) stimulated liver regeneration, improved liver function and increased survival after transplantation of 30% grafts. Phosphorylation of EGFR and its downstream signaling molecules Akt, mTOR, p70S6K, ERK and JNK increased markedly in 50% but not 30% grafts. AR stimulated EGFR phosphorylation and its downstream signaling pathways. EGFR inhibitor PD153035 suppressed regeneration of 50% grafts and largely abrogated stimulation of regeneration of 30% grafts by AR. AR also increased cyclin D1 and cyclin E expression in 30% grafts. Together, liver regeneration is suppressed in small-for-size grafts, as least in part, due to decreased AR formation. AR supplementation could be a promising therapy to stimulate regeneration of partial liver grafts.
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Affiliation(s)
- Q. Liu
- Department of Pharmaceutical & Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425,Department of General Surgery, the Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - H. Rehman
- Department of Pharmaceutical & Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Y. Krishnasamy
- Department of Pharmaceutical & Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - K. Haque
- Department of Pharmaceutical & Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - R.G. Schnellmann
- Department of Pharmaceutical & Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425,Ralph H. Johnson VA Medical Center, Charleston, SC 29403
| | - J.J. Lemasters
- Department of Pharmaceutical & Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425,Department of Biochemistry & Molecular Biology, Medical University of South Carolina, Charleston, SC 29425,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425
| | - Z. Zhong
- Department of Pharmaceutical & Biomedical Sciences, Medical University of South Carolina, Charleston, SC 29425,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425
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Kosieradzki M, Lisik W, Rowiński W, Małkowski P. Progress in abdominal organ transplantation. Med Sci Monit 2012; 17:RA282-91. [PMID: 22129915 PMCID: PMC3628136 DOI: 10.12659/msm.882119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The excellent results of vascularized organ transplantation have resulted in an increasing number of end-stage organ failure patients seeking such treatment. The results of organ transplantation depend on a number of factors – the quality of the donor (and an organ), living vs. deceased donation, magnitude of ischemic injury (and its prevention), and recipient-dependent factors. Ischemia/reperfusion injury in organ transplantation is a multifactorial process, which may lead to delayed graft function. In addition, surgical and preservation techniques, type of immunosuppressive regimens, complications after transplantation and post-transplant management may also have a significant impact on short- and long-term results of transplantation. In this paper we describe advances in transplantation in recent years, with particular emphasis on kidney, liver, intestines, whole pancreas and pancreatic islets.
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Affiliation(s)
- Maciej Kosieradzki
- Department of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
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