Outcomes with split liver transplantation in 106 recipients: the University of California, San Francisco, experience from 1993 to 2010.

BACKGROUND

Split liver transplantation (SLT) allows for expansion of the deceased donor pool.

OBJECTIVES

To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients.

DESIGN

Single-center retrospective review (September 18, 1993, to July 1, 2010).

SETTING

University medical center.

PATIENTS

One hundred six SLT recipients.

MAIN OUTCOME MEASURES

Postoperative graft and patient survival and postoperative complications.

RESULTS

In adults, 1-, 5-, and 10-year overall patient survival was 93%, 77%, and 73%, respectively; overall graft survival was 89%, 76%, and 65%, respectively; ex vivo split patient survival was 93%, 85%, and 74%, respectively; and ex vivo graft survival was 86%, 77%, and 63%, respectively. In situ split patient and graft survival was 94% at 1 year and 75% at 5 years. Postoperative complications included biliary (29%), vascular (11%), unplanned reexploratory surgery (11%), incisional hernia (8%), small-for-size syndrome (n = 1), need for shunt at the time of SLT (n = 1), and primary nonfunction (n = 1). In children, 1-, 5-, and 10-year overall patient survival was 84%, 75%, and 69%, respectively; overall graft survival was 77%, 63%, and 57%, respectively; ex vivo split patient survival was 83%, 73%, and 73%, respectively; and ex vivo graft survival was 75%, 59%, and 59%, respectively. In situ split patient and graft survival was 86% at 1 and 5 years. Postoperative complications included biliary (40%), vascular (26%), and primary nonfunction (n = 1).

CONCLUSIONS

Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.