Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Medicine (Baltimore). 2021 Oct 1;100(39):e27369. doi: 10.1097/MD.0000000000027369.
Liver transplantation has become a routine operation in many transplantation centers worldwide. However, liver graft availability fails to meet patient demands. Split liver transplantation (SPLT), which divides a deceased donor liver into 2 partial liver grafts, is a promising strategy for increasing graft availability for transplantation and ameliorating organ shortage to a certain degree. However, the transplantation community has not yet reached a consensus on SPLT because of the variable results. Specifically, SPLT for 2 adult recipients using full right/left hemi-liver grafts is clinically more challenging in terms of surgical technique and potential postoperative complications. Therefore, this review summarizes the current status of SPLT, focusing on the transplantation of adult recipients. Furthermore, the initiation of the SPLT program, donor allocation, surgical aspects, recipient outcomes, and obstacles to developing this procedure will be thoroughly discussed. This information might help provide an optimal strategy for implementing SPLT for 2 adult recipients among current transplantation societies. Meanwhile, potential obstacles to SPLT might be overcome in the near future with growing knowledge, experience, and refinement of surgical techniques. Ultimately, the widespread diffusion of SPLT may increase graft availability and mitigate organ donation shortages.
肝移植在世界范围内的许多移植中心已成为常规手术。然而，供肝的可获得性无法满足患者的需求。劈离式肝移植（SPLT）将供体肝脏分为 2 个部分肝移植，可以增加可用于移植的供体数量，在一定程度上改善器官短缺问题。但是，由于结果的差异，移植界尚未就 SPLT 达成共识。具体来说，使用完整的右/左半肝移植为 2 名成年受者进行 SPLT 在手术技术和潜在术后并发症方面具有更大的挑战性。因此，本文综述了 SPLT 的现状，重点介绍了成人受者的移植情况。此外，还将深入讨论 SPLT 项目的启动、供者分配、手术方面、受者结局以及开展该手术的障碍。这些信息可能有助于为当前移植协会中的 2 名成年受者实施 SPLT 提供最佳策略。同时，随着知识的不断积累、经验的不断丰富以及手术技术的不断完善，SPLT 的潜在障碍可能在不久的将来得到克服。最终，SPLT 的广泛应用可能会增加供体的可获得性，缓解器官捐献短缺的问题。
