Ann Surg 1996 Sep;224(3):331-9; discussion 339-41

In situ splitting of cadaveric livers. The ultimate expansion of a limited donor
pool.

Rogiers X, Malago M, Gawad K, Jauch KW, Olausson M, Knoefel WT, Gundlach M,
Bassas A, Fischer L, Sterneck M, Burdelski M, Broelsch CE

Department of Surgery, University Hospital Eppendorf, Hamburg, Germany.

Abstract

OBJECTIVE: The authors evaluate the safety, applicability, and effectiveness of
a new technique for split-liver transplantation. SUMMARY BACKGROUND DATA:
Split-liver transplantation offers an attractive way to increase the donor pool
for cadaveric liver transplantation. The application of this concept has been
hampered by inferior patient and graft survivals and higher complication rates.
Without supportive data, the concern about increasing biliary leakage and poor
initial graft function persisted. The authors focused on the causes of these
complications by presenting a new technique to eliminate these problems.
METHODS: Liver splitting was performed in the heart-beating cadaveric organ
donor, using the technique described for procurement of the left lateral lobe of
a live donor. A detailed description of the technique is presented. A
retrospective review of the first 14 transplantations resulting from 7 in situ
splitting procedures was collected. The results were compared with 19
conventional split-liver transplants performed during the same period. RESULTS:
Six-month patient and graft survivals after in situ split-liver transplantation
were 92.8% and 85.7%, respectively. Biliary complications were absent.
Postoperative courses were mostly uneventful and characterized by lower peak
transaminase levels compared with standard techniques. Early graft function of
extrahepatic organs procured simultaneously was excellent. CONCLUSIONS: In situ
split-liver transplantation provides superior results, related mainly to
reduction of cold ischemic damage of the grafts and avoidance of biliary
complications. In situ split-liver transplantation renders graft reduction alone
obsolete and opens a donor pool for adults to receive right lobes safely. It
allows for long-distance sharing between pediatric and adult liver transplant
units because the procedure abolishes ex situ benching and prolonged ischemia
time and provides two anatomically perfect grafts with hemostasis accomplished.