To report the results of a multicenter experience of split liver transplantation (SLT) with pediatric donors.
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.
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.
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.
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.
A multicenter experience of split liver transplantation with pediatric donors revealed that this strategy can effectively increase organ availability, with a benefit for both adult and pediatric patients. The use of partial grafts from donors weighing less than 40 kg needs careful assessment.
From the *Liver and Lung Transplantation Unit, Azienda Ospedaliera “Ospedali Riuniti,” Bergamo, Italy; †Department of Surgery, Abdominal Transplantation Unit, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IsMeTT), University of Pittsburgh Medical Center (UPMC), Palermo, Italy; ‡Department of Pediatrics, Azienda Ospedaliera “Ospedali Riuniti,” Bergamo, Italy; §Department of Transplant Surgery, Ospedale San Martino, University of Genoa, Genoa, Italy; ¶Department of General and Transplantation Surgery, Liver and Lung Transplantation Unit, IRCCS Ospedale Maggiore, University of Milan, Italy; ∥Department of General and Transplantation Surgery, General Surgery Unit I, University of Padua, Italy; **Department of Surgery, Transplantation Unit, University Hospital, Udine, Italy; ††Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy; ‡‡Department of Surgery, Transplantation Unit, Ospedale Sant'Eugenio, Tor Vergata University, Rome, Italy; §§Liver Transplantation Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy; ¶¶Department of Surgery, Transplantation Unit, Policlinico Umberto I, La Sapienza University of Rome, Italy; ∥∥Department of Digestive Surgery and Liver Transplantation, Regina Elena Cancer Institute, Rome, Italy; ***Liver Transplantation Center, Ospedale San Giovanni Battista, Turin, Italy; †††Laparoscopic and Liver and Transplantation Surgery Unit, Ospedale Cardarelli, Naples, Italy; ‡‡‡Organ and Tissue Transplant Immunology Unit, IRCCS Ospedale Maggiore, Milan, Italy.
Reprints: Marco Spada, MD, PhD, Department of Surgery, Abdominal Transplantation Unit, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IsMeTT), UPMC Italy, Via E. Tricomi, 1, 90127 Palermo, Italy. E-mail: firstname.lastname@example.org.