Decoster E L, Troisi R, Sainz-Barriga M, Haentjens I, Colenbie L, Geerts A, Colle I, Van Vlierberghe H, de Hemptinne B, Rogiers X
Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent 9000, Belgium.
Transplant Proc. 2009 Oct;41(8):3485-8. doi: 10.1016/j.transproceed.2009.09.009.
Split liver transplantation (SLT) allows grafting of 2 recipients with 1 allograft. Results of adult SLT have improved since its first introduction. Children benefit most from SLT, while among some adult liver transplanters there are concerns about splitting a liver, turning a good quality graft into a marginal one. We performed a single center retrospective review to address this issue.
Between June 2001 and August 2008, we performed 22 extended right liver graft (eRLG) transplantations in 21 adult patients.
Eleven donors (50%) did not meet the Eurotransplant criteria for optimal donors. Forty-one percent of eRLG donors showed hemodynamic instability at the time of harvest. Eighteen (82%) splitting procedures were performed ex situ. The main indications for transplantation were alcoholic liver cirrhosis (32%), hepatitis C-related cirrhosis (18%), and acute liver failure (18%). Mean recipient age was 54 years (range, 17-69 years); median Model for End-Stage Liver Disease (MELD) score was 15 (range, 7-40). Patients were followed for a median of 16 months (range, 4-92 months) following transplantation. We observed 5 (23%) vascular and 3 (14%) biliary complications. Overall patient survival was 84% at 3 years; overall graft survival was 79%. For the 11 patients who had undergone transplantation after 2007, we observed a 100% patient and graft survival.
After an initial learning curve and provided careful selection, exceptions to classical donor criteria for splitting can be accepted with successful outcomes comparable to those after whole liver transplantation.
劈离式肝移植（SLT）可使一个同种异体移植物移植给两名受者。自首次引入以来，成人SLT的结果有所改善。儿童从SLT中获益最大，而在一些成人肝移植医生中，有人担心将肝脏劈开会把一个质量良好的移植物变成边缘性移植物。我们进行了一项单中心回顾性研究以解决这一问题。
2001年6月至2008年8月期间，我们对21例成年患者进行了22例扩大右肝移植物（eRLG）移植。
11名供者（50%）不符合欧洲移植组织关于最佳供者的标准。41%的eRLG供者在获取时出现血流动力学不稳定。18例（82%）劈离操作是在体外进行的。主要移植适应证为酒精性肝硬化（32%）、丙型肝炎相关肝硬化（18%）和急性肝衰竭（18%）。受者平均年龄为54岁（范围17 - 69岁）；终末期肝病模型（MELD）评分中位数为15（范围7 - 40）。移植后患者的中位随访时间为16个月（范围4 - 92个月）。我们观察到5例（23%）血管并发症和3例（14%）胆道并发症。3年时患者总体生存率为84%；移植物总体生存率为79%。对于2007年后接受移植的11例患者，我们观察到患者和移植物生存率均为100%。
经过最初的学习曲线并进行仔细选择后，对于劈离经典供者标准的例外情况可以接受，其成功结果与全肝移植相当。
