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Annals of Surgery:
doi: 10.1097/01.sla.0000218076.85213.60
Original Articles

Feasibility and Limits of Split Liver Transplantation From Pediatric Donors: An Italian Multicenter Experience

Cescon, Matteo MD*; Spada, Marco MD, PhD†; Colledan, Michele MD*; Torre, Giuliano MD‡; Andorno, Enzo MD§; Valente, Umberto MD§; Rossi, Giorgio MD¶; Reggiani, Paolo MD¶; Cillo, Umberto MD∥; Baccarani, Umberto MD**; Grazi, Gian Luca MD††; Tisone, Giuseppe MD‡‡; Filipponi, Franco MD§§; Rossi, Massimo MD¶¶; Ettorre, Giuseppe Maria MD∥∥; Salizzoni, Mauro MD***; Cuomo, Oreste MD†††; De Feo, Tullia MD‡‡‡; Gridelli, Bruno MD†

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Abstract

Objective: To report the results of a multicenter experience of split liver transplantation (SLT) with pediatric donors.

Summary Background Data: There are no reports in the literature regarding pediatric liver splitting; further; the use of donors weighing <40 kg for SLT is currently not recommended.

Methods: From 1997 to 2004, 43 conventional split liver procedures from donors aged <15 years were performed. Nineteen donors weighing ≤40 kg and 24 weighing >40 kg were used. Dimensional matching was based on donor-to-recipient weight ratio (DRWR) for left lateral segment (LLS) and on estimated graft-to-recipient weight ratio (eGRWR) for extended right grafts (ERG). In 3 cases, no recipient was found for an ERG. The celiac trunk was retained with the LLS in all but 1 case. Forty LLSs were transplanted into 39 children, while 39 ERGs were transplanted into 11 children and 28 adults.

Results: Two-year patient and graft survival rates were not significantly different between recipients of donors ≤40 kg and >40 kg, between pediatric and adult recipients, and between recipients of LLSs and ERGs. Vascular complication rates were 12% in the ≤40 kg donor group and 6% in the >40 kg donor group (P = not significant). There were no differences in the incidence of other complications. Donor ICU stay >3 days and the use of an interposition arterial graft were associated with an increased risk of graft loss and arterial complications, respectively.

Conclusions: Splitting of pediatric liver grafts is an effective strategy to increase organ availability, but a cautious evaluation of the use of donors ≤40 kg is necessary. Prolonged donor ICU stay is associated with poorer outcomes. The maintenance of the celiac trunk with LLS does not seem detrimental for right-sided grafts, whereas the use of interposition grafts for arterial reconstruction should be avoided.

© 2006 Lippincott Williams & Wilkins, Inc.

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