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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

doi: 10.1097/01.sla.0000218076.85213.60
Original Articles

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.

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: mspada@ismett.edu.

© 2006 Lippincott Williams & Wilkins, Inc.