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Feasibility and Limits of Split Liver Transplantation From Pediatric Donors

2006; Lippincott Williams & Wilkins; Volume: 244; Issue: 5 Linguagem: Inglês

10.1097/01.sla.0000218076.85213.60

1528-1140

Matteo Cescon, Marco Spada, M. Colledan, Giuliano Torre, Enzo Andorno, Umberto Valente, G. Rossi, P. Reggiani, Umberto Cillo, Umberto Baccarani, Gian Luca Grazi, Giuseppe Tisone, Franco Filipponi, Massimo Rossi, Giuseppe Maria Ettorre, Mauro Salizzoni, O. Cuomo, Tullia De Feo, Bruno Gridelli,

Organ Donation and Transplantation

In Brief Objective: To report the results of a multicenter experience of split liver transplantation (SLT) with pediatric donors. Summary Background Data: There are no reports in the literature regarding pediatric liver splitting; further; the use of donors weighing <40 kg for SLT is currently not recommended. Methods: From 1997 to 2004, 43 conventional split liver procedures from donors aged 40 kg were used. Dimensional matching was based on donor-to-recipient weight ratio (DRWR) for left lateral segment (LLS) and on estimated graft-to-recipient weight ratio (eGRWR) for extended right grafts (ERG). In 3 cases, no recipient was found for an ERG. The celiac trunk was retained with the LLS in all but 1 case. Forty LLSs were transplanted into 39 children, while 39 ERGs were transplanted into 11 children and 28 adults. Results: Two-year patient and graft survival rates were not significantly different between recipients of donors ≤40 kg and >40 kg, between pediatric and adult recipients, and between recipients of LLSs and ERGs. Vascular complication rates were 12% in the ≤40 kg donor group and 6% in the >40 kg donor group (P = not significant). There were no differences in the incidence of other complications. Donor ICU stay >3 days and the use of an interposition arterial graft were associated with an increased risk of graft loss and arterial complications, respectively. Conclusions: Splitting of pediatric liver grafts is an effective strategy to increase organ availability, but a cautious evaluation of the use of donors ≤40 kg is necessary. Prolonged donor ICU stay is associated with poorer outcomes. The maintenance of the celiac trunk with LLS does not seem detrimental for right-sided grafts, whereas the use of interposition grafts for arterial reconstruction should be avoided. A multicenter experience of split liver transplantation with pediatric donors revealed that this strategy can effectively increase organ availability, with a benefit for both adult and pediatric patients. The use of partial grafts from donors weighing less than 40 kg needs careful assessment.