Kilic M, Seu P, Stribling R J, Ghalib R, Goss J A
Baylor College of Medicine Michael E. DeBakey Department of Surgery, Houston, Texas 77030, USA.
Transplantation. 2001 Dec 15;72(11):1853-8. doi: 10.1097/00007890-200112150-00028.
Split-liver transplantation offers a unique opportunity to expand the existing donor pool. However, it has previously been stated that due to inadequate liver volume the advantages of split-liver transplantation would be lost when attempting to split the liver for two adult recipients. In this study, we sought to determine the safety, efficacy, and applicability of split-liver transplantation in select adult liver transplant recipients.
Liver allografts for eight adult recipients were procured by in situ splitting of four adult cadaveric livers. The donor ages were 17, 19, 22, and 25 years and weights were 72, 77, 78, and 87 kg, respectively. In situ splitting resulted in three right trisegmental grafts, one right lobe graft, one left lobe graft, and three left lateral segmental grafts. The median recipient age was 49 years (range 38-61 years), whereas the median recipient weight was 84 kg (range 78-98 kg) for the right-sided grafts and 52 kg (range 51-53 kg) for recipients of the left-sided grafts. The median graft-to-recipient body weight ratio for right trisegmental, right lobe, left lobe, and left lateral segmental grafts was 1.31%, 1.26%, 1.35%, and 0.70%, respectively.
Overall patient and graft survival in this series is 100%. All prothrombin times were normalized within 4 days of transplantation. No evidence of ascites or prolonged hyperbilirubinemia was encountered in any right- or left-sided graft recipient. The incidence of hepatic artery, portal vein, and hepatic vein thrombosis is 0%, 0%, and 0%, respectively. Hepatic arterial anastomotic bleeding and a cut surface bile leak each occurred in one patient. Median United Network for Organ Sharing (UNOS) waiting time was 242 days (range 4-454 days) for the patients to which the donor liver was allocated. In contrast, the median waiting time for the four patients receiving the extra split-liver graft was reduced significantly to 37 days (range 21-101 days) (P<0.02).
This study demonstrates that split-liver transplantation can expand the cadaveric donor liver pool available for select adult liver transplant recipients. When both the donor organ and the transplant recipient are chosen carefully, split-liver transplantation can be safely performed without a delay in allograft function, increase in technical complications, or compromise in graft or patient survival.
劈离式肝移植为扩大现有供体库提供了独特的机会。然而，此前曾有人指出，由于肝体积不足，试图将肝脏劈分给两名成年受者时，劈离式肝移植的优势将会丧失。在本研究中，我们试图确定劈离式肝移植在特定成年肝移植受者中的安全性、有效性和适用性。
通过原位劈分4个成年尸体肝脏，获取用于8名成年受者的肝移植供体。供体年龄分别为17、19、22和25岁，体重分别为72、77、78和87千克。原位劈分产生了3个右三叶移植肝、1个右叶移植肝、1个左叶移植肝和3个左外叶移植肝。受者年龄中位数为49岁（范围38 - 61岁），右侧移植肝受者的体重中位数为84千克（范围78 - 98千克），左侧移植肝受者的体重中位数为52千克（范围51 - 53千克）。右三叶、右叶、左叶和左外叶移植肝的移植肝与受者体重比中位数分别为1.31%、1.26%、1.35%和0.70%。
本系列研究中患者和移植肝的总体存活率均为100%。所有凝血酶原时间在移植后4天内恢复正常。在任何右侧或左侧移植肝受者中均未发现腹水或长期高胆红素血症的证据。肝动脉、门静脉和肝静脉血栓形成的发生率分别为0%、0%和0%。肝动脉吻合口出血和切面胆漏各发生在1例患者中。分配供体肝脏的患者，器官共享联合网络（UNOS）等待时间中位数为242天（范围4 - 454天）。相比之下，接受额外劈分肝移植的4例患者的等待时间中位数显著缩短至37天（范围21 - 101天）（P<0.02）。
本研究表明，劈离式肝移植可以扩大可供特定成年肝移植受者使用的尸体供肝库。当仔细选择供体器官和移植受者时，劈离式肝移植可以安全进行，不会延迟移植肝功能，不会增加技术并发症，也不会损害移植肝或患者的存活率。
