Ann Liver Transplant.  2022 Nov;2(2):112-116. 10.52604/alt.22.0023.

Split liver transplantation for one adult and one pediatric recipient: A collective review of Korean experience

• Park CS
• Park JI

• KMID: 2560904
• DOI: http://doi.org/10.52604/alt.22.0023

Abstract

Split liver transplantation (SLT) was developed to increase the number of donor graft livers used for liver transplantation. In conventional SLT, the liver of the deceased donor is divided into two parts, the left lateral section for pediatric recipients and the extended right liver graft for adult recipients. This review presents the Korean experience of SLT for adult and pediatric recipients to delineate the characteristics of SLT. An analysis of the multicenter experience using the Korean Network for Organ Sharing data revealed that a sufficient volume of the graft estimated from donor-to-recipient weight ratio-matching could lead to better outcomes of adult SLTs with an extended right liver graft. A single-center experience of SLT on adult recipients presented that survival outcomes were similar in adult SLT and whole liver transplantation recipients, probably due to selection of high-quality grafts and low-risk recipients. An analysis of the Korean multi-center experience on pediatric recipients presented that the graft and overall survival rates of SLT and living donor liver transplantation were not different in pediatric patients, and that fulminant hepatic failure was the only risk factor affecting graft survival outcome. In conclusion, this collective review demonstrated that survival outcomes were comparable between adult SLT and whole liver transplantation recipients as well as pediatric SLT and living donor liver transplantation. Judicious selection of donors and adult recipients for SLT might expand the liver graft pool for pediatric patients without affecting adult recipients undergoing SLT.

Keyword

Deceased donor; Liver transplantation; Liver splitting; Pediatric recipient; Left lateral section graft

Reference

1. Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H. 1988; [Transplantation of a donor liver to 2 recipients (splitting transplantation)--a new method in the further development of segmental liver transplantation]. Langenbecks Arch Chir. 373:127–130. German. DOI: 10.1007/BF01262776. PMID: 3287073.

2. Broelsch CE, Emond JC, Whitington PF, Thistlethwaite JR, Baker AL, Lichtor JL. 1990; Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg. 212:368–375. DOI: 10.1097/00000658-199009000-00015. PMID: 2396888. PMCID: PMC1358174.

3. Renz JF, Yersiz H, Reichert PR, Hisatake GM, Farmer DG, Emond JC, et al. 2003; Split-liver transplantation: a review. Am J Transplant. 3:1323–1335. DOI: 10.1046/j.1600-6135.2003.00254.x. PMID: 14525591.

4. Adam R, McMaster P, O'Grady JG, Castaing D, Klempnauer JL, Jamieson N, et al. European Liver Transplant Association. DOI: 10.1016/j.lts.2003.09.018. PMID: 14625822.

5. Superina R. 2012; To split or not to split: that is the question. Liver Transpl. 18:389–390. DOI: 10.1002/lt.23397. PMID: 22287492.

6. Yoon KC, Song S, Jwa EK, Lee S, Kim JM, Kim O, et al. 2018; Survival outcomes in split compared with whole liver transplantation. Liver Transpl. 24:1411–1424. DOI: 10.1002/lt.25196. PMID: 29747216.

7. Jung DH, Hwang S, Song GW, Ahn CS, Moon DB, Kim KH, et al. 2017; In situ split liver transplantation for 2 adult recipients: a single-center experience. Ann Transplant. 22:230–240. DOI: 10.12659/AOT.902567. PMID: 28428535. PMCID: PMC6248301.

8. Kim JS, Broering DC, Tustas RY, Fischer L, Ganschow R, Burdelski M, et al. 2004; Split liver transplantation: past, present and future. Pediatr Transplant. 8:644–648. DOI: 10.1111/j.1399-3046.2004.00264.x. PMID: 15598341.

9. Cardillo M, De Fazio N, Pedotti P, De Feo T, Fassati LR, Mazzaferro V, et al. NITp Liver Transplantation Working Group. DOI: 10.1002/lt.20720. PMID: 16598843.

10. Suh KS, Lee HW, Shin WY, Cho EH, Yi NJ, Lee KU. 2007; Split liver transplantation. J Korean Soc Transplant. 21:135–139.

11. Lee S, Lee SK. 2013; Pediatric liver transplantation. J Korean Assoc Pediatr Surg. 19:14–21. DOI: 10.13029/jkaps.2013.19.1.14.

12. Yersiz H, Renz JF, Farmer DG, Hisatake GM, McDiarmid SV, Busuttil RW. 2003; One hundred in situ split-liver transplantations: a single-center experience. Ann Surg. 238:496–505. DOI: 10.1097/01.sla.0000089852.29654.72. PMID: 14530721. PMCID: PMC1360108.

13. Hwang S, Lee SG, Park KM, Kim KH, Ahn CS, Moon DB, et al. 2004; A case report of split liver transplantation for two adult recipients in Korea. Transplant Proc. 36:2736–2740. DOI: 10.1016/j.transproceed.2004.09.042. PMID: 15621136.

14. Gavriilidis P, Roberts KJ, Azoulay D. 2018; Right lobe split liver graft versus whole liver transplantation: a systematic review by updated traditional and cumulative meta-analysis. Dig Liver Dis. 50:1274–1282. DOI: 10.1016/j.dld.2018.08.025. PMID: 30236766.

15. Hwang S, Lee SG, Lee YJ, Park KM, Ahn CS, Kim KH. 2006; Postoperative changes in remnant medial segment parenchyma of living donor livers after procurement of left lateral segment graft. Hepatogastroenterology. 53:773–777.

16. Suh KS, Lee KW, Koh YT, Roh HR, Chung JK, Minn KW, et al. 2000; First successful in situ split-liver transplantation in Korea. Transplant Proc. 32:2140. DOI: 10.1016/S0041-1345(00)01606-7. PMID: 11120105.

17. Park GC, Hwang S, Song GW, Jung DH, Ha TY, Ahn CS, et al. 2020; Prognosis of split liver transplantation compared with whole liver transplantation in adult patients: single-center results under the Korean MELD score-based allocation policy. J Korean Med Sci. 35:e304. DOI: 10.3346/jkms.2020.35.e304. PMID: 32959541. PMCID: PMC7505731.

18. Yoon KC, Song S, Lee S, Kim OK, Hong SK, Yi NJ, et al. 2022; Outcomes of split liver transplantation vs living donor liver transplantation in pediatric patients: a 5-year follow-up study in Korea. Ann Transplant. 27:e935682. DOI: 10.12659/AOT.935682. PMID: 35502129. PMCID: PMC9084422.

19. Min SI, Ahn C, Han DJ, Kim SI, Chung SY, Lee SK, et al. 2015; To achieve national self-sufficiency: recent progresses in deceased donation in Korea. Transplantation. 99:765–770. DOI: 10.1097/TP.0000000000000412. PMID: 25226175.

20. Ha HS, Hong JJ, Kim IO, Lee SR, Lee AY, Ha TY, et al. 2019; Deceased donor liver transplantation under the Korean model for end-stage liver disease score-based liver allocation system: 2-year allocation results at a high-volume transplantation center. Korean J Transplant. 33:112–117. Erratum. DOI: 10.4285/jkstn.2019.33.4.112. PMID: 35769978. PMCID: PMC9188943.

21. Cho WH. 2019; Organ donation in Korea in 2018 and an introduction of the Korea national organ donation system. Korean J Transplant. 33:83–97. DOI: 10.4285/jkstn.2019.33.4.83. PMID: 35769975. PMCID: PMC9188944.

22. Choi Y, Lee KW, Hong G, Kim H, Park MS, Suh S, et al. 2012; Status and current problems in the allocation system for pediatric liver transplantation in Korea. J Korean Soc Transplant. 26:196–201. DOI: 10.4285/jkstn.2012.26.3.196.