In situ splitting of the cadaveric liver for transplantation

John A. Goss, Hasan Yersiz, Christopher R. Shackleton, Philip Seu, Craig V. Smith, Jay S. Markowitz, Douglas G. Farmer, R. Mark Ghobrial, James F. Markmann, Walid S. Arnaout, David K. Imagawa, Steven D. Colquhoun, Mark H. Fraiman, Sue V. McDiarmid, Ronald W. Busuttil

Research output: Contribution to journalArticle

162 Citations (Scopus)

Abstract

Background. The shortage of cadaveric donor livers is the rate-limiting step in clinical liver transplantation. Split liver transplantation provides a means to expand the cadaveric donor pool. However, this concept has not reached its full potential because of inferior patient and graft survival and high complication rates when traditional ex vivo split techniques are used. Therefore we sought to evaluate the safety, applicability, and effectiveness of a new technique for split liver transplantation. Methods. This study consists of 15 in situ split liver procurements, which resulted in 28 liver transplants. In situ splitting of selected livers from hemodynamically stable cadaveric donors was performed at the donor hospital without any additional work-up or equipment being needed. In situ liver splitting is accomplished in a manner identical to the living-donor procurement. This technique for liver splitting results in a left lateral segment graft (segments 2 and 3) and a right trisegmental graft (segments 1 and 4-8). This procedure required the use of the donor hospital operating room for an additional 1.5-2.5 hr and did not interfere with the procurement of 30 kidneys, 12 hearts, 7 lungs, and 9 pancreata from these same donors. Results. The 6-month and 1-year actuarial patient survival rates were 92% and 92%, respectively, while the 6-month and 1-year actuarial graft survival rates were 86% and 86%, respectively. The 6- month and 1-year actuarial patient survival rate of patients who received a left lateral segment graft was 100% and 100%, respectively, while those who received a right trisegmental graft had 6-month and 1-year rates of 86% and 86%, respectively. The actuarial death-censored graft survival rates at 6 months and 1 year were 80% and 80%, respectively, for the left lateral segment grafts, and 93% and 90%, respectively, for the right trisegmental grafts. Allograft and patient survival was independent of United Network for Organ Sharing status at the time of liver transplantation. No patient developed a biliary stricture, required re-exploration for intra-abdominal hemorrhage, or suffered from portal vein, hepatic vein, or hepatic artery thrombosis. Conclusions. In situ split liver transplantation can be accomplished without complications and provides results that are superior to those obtained previously with ex vivo methods. It abolishes ex vivo benching and prolonged ischemia times and provides two optimal grafts with hemostasis accomplished. This technique decreases pediatric waiting time and allows adult recipients to receive right-sided grafts safely. In situ splitting is the method of choice for expanding the cadaveric liver donor pool.

Original languageEnglish (US)
Pages (from-to)871-877
Number of pages7
JournalTransplantation
Volume64
Issue number6
DOIs
StatePublished - Sep 27 1997

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Liver Transplantation
Transplants
Tissue Donors
Liver
Graft Survival
Survival Rate
Hepatic Veins
Living Donors
Hepatic Artery
Operating Rooms
Portal Vein
Hemostasis
Allografts
Pancreas
Pathologic Constriction
Thrombosis
Ischemia
Pediatrics
Hemorrhage
Kidney

ASJC Scopus subject areas

  • Transplantation

Cite this

Goss, J. A., Yersiz, H., Shackleton, C. R., Seu, P., Smith, C. V., Markowitz, J. S., ... Busuttil, R. W. (1997). In situ splitting of the cadaveric liver for transplantation. Transplantation, 64(6), 871-877. https://doi.org/10.1097/00007890-199709270-00014

In situ splitting of the cadaveric liver for transplantation. / Goss, John A.; Yersiz, Hasan; Shackleton, Christopher R.; Seu, Philip; Smith, Craig V.; Markowitz, Jay S.; Farmer, Douglas G.; Ghobrial, R. Mark; Markmann, James F.; Arnaout, Walid S.; Imagawa, David K.; Colquhoun, Steven D.; Fraiman, Mark H.; McDiarmid, Sue V.; Busuttil, Ronald W.

In: Transplantation, Vol. 64, No. 6, 27.09.1997, p. 871-877.

Research output: Contribution to journalArticle

Goss, JA, Yersiz, H, Shackleton, CR, Seu, P, Smith, CV, Markowitz, JS, Farmer, DG, Ghobrial, RM, Markmann, JF, Arnaout, WS, Imagawa, DK, Colquhoun, SD, Fraiman, MH, McDiarmid, SV & Busuttil, RW 1997, 'In situ splitting of the cadaveric liver for transplantation', Transplantation, vol. 64, no. 6, pp. 871-877. https://doi.org/10.1097/00007890-199709270-00014
Goss JA, Yersiz H, Shackleton CR, Seu P, Smith CV, Markowitz JS et al. In situ splitting of the cadaveric liver for transplantation. Transplantation. 1997 Sep 27;64(6):871-877. https://doi.org/10.1097/00007890-199709270-00014
Goss, John A. ; Yersiz, Hasan ; Shackleton, Christopher R. ; Seu, Philip ; Smith, Craig V. ; Markowitz, Jay S. ; Farmer, Douglas G. ; Ghobrial, R. Mark ; Markmann, James F. ; Arnaout, Walid S. ; Imagawa, David K. ; Colquhoun, Steven D. ; Fraiman, Mark H. ; McDiarmid, Sue V. ; Busuttil, Ronald W. / In situ splitting of the cadaveric liver for transplantation. In: Transplantation. 1997 ; Vol. 64, No. 6. pp. 871-877.
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title = "In situ splitting of the cadaveric liver for transplantation",
abstract = "Background. The shortage of cadaveric donor livers is the rate-limiting step in clinical liver transplantation. Split liver transplantation provides a means to expand the cadaveric donor pool. However, this concept has not reached its full potential because of inferior patient and graft survival and high complication rates when traditional ex vivo split techniques are used. Therefore we sought to evaluate the safety, applicability, and effectiveness of a new technique for split liver transplantation. Methods. This study consists of 15 in situ split liver procurements, which resulted in 28 liver transplants. In situ splitting of selected livers from hemodynamically stable cadaveric donors was performed at the donor hospital without any additional work-up or equipment being needed. In situ liver splitting is accomplished in a manner identical to the living-donor procurement. This technique for liver splitting results in a left lateral segment graft (segments 2 and 3) and a right trisegmental graft (segments 1 and 4-8). This procedure required the use of the donor hospital operating room for an additional 1.5-2.5 hr and did not interfere with the procurement of 30 kidneys, 12 hearts, 7 lungs, and 9 pancreata from these same donors. Results. The 6-month and 1-year actuarial patient survival rates were 92{\%} and 92{\%}, respectively, while the 6-month and 1-year actuarial graft survival rates were 86{\%} and 86{\%}, respectively. The 6- month and 1-year actuarial patient survival rate of patients who received a left lateral segment graft was 100{\%} and 100{\%}, respectively, while those who received a right trisegmental graft had 6-month and 1-year rates of 86{\%} and 86{\%}, respectively. The actuarial death-censored graft survival rates at 6 months and 1 year were 80{\%} and 80{\%}, respectively, for the left lateral segment grafts, and 93{\%} and 90{\%}, respectively, for the right trisegmental grafts. Allograft and patient survival was independent of United Network for Organ Sharing status at the time of liver transplantation. No patient developed a biliary stricture, required re-exploration for intra-abdominal hemorrhage, or suffered from portal vein, hepatic vein, or hepatic artery thrombosis. Conclusions. In situ split liver transplantation can be accomplished without complications and provides results that are superior to those obtained previously with ex vivo methods. It abolishes ex vivo benching and prolonged ischemia times and provides two optimal grafts with hemostasis accomplished. This technique decreases pediatric waiting time and allows adult recipients to receive right-sided grafts safely. In situ splitting is the method of choice for expanding the cadaveric liver donor pool.",
author = "Goss, {John A.} and Hasan Yersiz and Shackleton, {Christopher R.} and Philip Seu and Smith, {Craig V.} and Markowitz, {Jay S.} and Farmer, {Douglas G.} and Ghobrial, {R. Mark} and Markmann, {James F.} and Arnaout, {Walid S.} and Imagawa, {David K.} and Colquhoun, {Steven D.} and Fraiman, {Mark H.} and McDiarmid, {Sue V.} and Busuttil, {Ronald W.}",
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language = "English (US)",
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T1 - In situ splitting of the cadaveric liver for transplantation

AU - Goss, John A.

AU - Yersiz, Hasan

AU - Shackleton, Christopher R.

AU - Seu, Philip

AU - Smith, Craig V.

AU - Markowitz, Jay S.

AU - Farmer, Douglas G.

AU - Ghobrial, R. Mark

AU - Markmann, James F.

AU - Arnaout, Walid S.

AU - Imagawa, David K.

AU - Colquhoun, Steven D.

AU - Fraiman, Mark H.

AU - McDiarmid, Sue V.

AU - Busuttil, Ronald W.

PY - 1997/9/27

Y1 - 1997/9/27

N2 - Background. The shortage of cadaveric donor livers is the rate-limiting step in clinical liver transplantation. Split liver transplantation provides a means to expand the cadaveric donor pool. However, this concept has not reached its full potential because of inferior patient and graft survival and high complication rates when traditional ex vivo split techniques are used. Therefore we sought to evaluate the safety, applicability, and effectiveness of a new technique for split liver transplantation. Methods. This study consists of 15 in situ split liver procurements, which resulted in 28 liver transplants. In situ splitting of selected livers from hemodynamically stable cadaveric donors was performed at the donor hospital without any additional work-up or equipment being needed. In situ liver splitting is accomplished in a manner identical to the living-donor procurement. This technique for liver splitting results in a left lateral segment graft (segments 2 and 3) and a right trisegmental graft (segments 1 and 4-8). This procedure required the use of the donor hospital operating room for an additional 1.5-2.5 hr and did not interfere with the procurement of 30 kidneys, 12 hearts, 7 lungs, and 9 pancreata from these same donors. Results. The 6-month and 1-year actuarial patient survival rates were 92% and 92%, respectively, while the 6-month and 1-year actuarial graft survival rates were 86% and 86%, respectively. The 6- month and 1-year actuarial patient survival rate of patients who received a left lateral segment graft was 100% and 100%, respectively, while those who received a right trisegmental graft had 6-month and 1-year rates of 86% and 86%, respectively. The actuarial death-censored graft survival rates at 6 months and 1 year were 80% and 80%, respectively, for the left lateral segment grafts, and 93% and 90%, respectively, for the right trisegmental grafts. Allograft and patient survival was independent of United Network for Organ Sharing status at the time of liver transplantation. No patient developed a biliary stricture, required re-exploration for intra-abdominal hemorrhage, or suffered from portal vein, hepatic vein, or hepatic artery thrombosis. Conclusions. In situ split liver transplantation can be accomplished without complications and provides results that are superior to those obtained previously with ex vivo methods. It abolishes ex vivo benching and prolonged ischemia times and provides two optimal grafts with hemostasis accomplished. This technique decreases pediatric waiting time and allows adult recipients to receive right-sided grafts safely. In situ splitting is the method of choice for expanding the cadaveric liver donor pool.

AB - Background. The shortage of cadaveric donor livers is the rate-limiting step in clinical liver transplantation. Split liver transplantation provides a means to expand the cadaveric donor pool. However, this concept has not reached its full potential because of inferior patient and graft survival and high complication rates when traditional ex vivo split techniques are used. Therefore we sought to evaluate the safety, applicability, and effectiveness of a new technique for split liver transplantation. Methods. This study consists of 15 in situ split liver procurements, which resulted in 28 liver transplants. In situ splitting of selected livers from hemodynamically stable cadaveric donors was performed at the donor hospital without any additional work-up or equipment being needed. In situ liver splitting is accomplished in a manner identical to the living-donor procurement. This technique for liver splitting results in a left lateral segment graft (segments 2 and 3) and a right trisegmental graft (segments 1 and 4-8). This procedure required the use of the donor hospital operating room for an additional 1.5-2.5 hr and did not interfere with the procurement of 30 kidneys, 12 hearts, 7 lungs, and 9 pancreata from these same donors. Results. The 6-month and 1-year actuarial patient survival rates were 92% and 92%, respectively, while the 6-month and 1-year actuarial graft survival rates were 86% and 86%, respectively. The 6- month and 1-year actuarial patient survival rate of patients who received a left lateral segment graft was 100% and 100%, respectively, while those who received a right trisegmental graft had 6-month and 1-year rates of 86% and 86%, respectively. The actuarial death-censored graft survival rates at 6 months and 1 year were 80% and 80%, respectively, for the left lateral segment grafts, and 93% and 90%, respectively, for the right trisegmental grafts. Allograft and patient survival was independent of United Network for Organ Sharing status at the time of liver transplantation. No patient developed a biliary stricture, required re-exploration for intra-abdominal hemorrhage, or suffered from portal vein, hepatic vein, or hepatic artery thrombosis. Conclusions. In situ split liver transplantation can be accomplished without complications and provides results that are superior to those obtained previously with ex vivo methods. It abolishes ex vivo benching and prolonged ischemia times and provides two optimal grafts with hemostasis accomplished. This technique decreases pediatric waiting time and allows adult recipients to receive right-sided grafts safely. In situ splitting is the method of choice for expanding the cadaveric liver donor pool.

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