Ann Surg 1996 Dec;224(6):737-46; discussion 746-8

Split-liver transplantation. The Paul Brousse policy

Azoulay D, Astarcioglu I, Bismuth H, Castaing D, Majno P, Adam R, Johann M

Abstract
OBJECTIVE: The authors objective is to report their recent experience with
split-liver transplantation, focusing on the results and the impact on organ
shortage. SUMMARY BACKGROUND DATA: There is an insufficient number of organs for
liver transplantation. Split-liver transplantation is a method to increase the
number of grafts, but the procedure is slow to gain wide acceptance because of
its complexity and the poor results reported in previous series. METHODS: During
the year 1995, the authors split 20 of 83 transplantable livers allocated to the
authors' center, generating 40 grafts: 23 were transplanted locally and 17 were
given to partner centers. During the same period, the authors accepted four
split-liver grafts proposed to them by other centers. Overall, 27 split-liver
transplantations were done in the authors' unit, accounting for 30% of the 90
transplants performed in 1995. RESULTS: One-year patient and graft survival
rates for split-liver transplantation were 79.4% and 78.5%, respectively.
Arterial and biliary complications rates were 15% and 22%, respectively, with
none leading to graft loss. Primary nonfunction occurred in one case (4%). By
splitting 24 of 87 transplantable livers (4 of which were in partner units), a
total of 111 transplantations were performed, increasing graft availability by
28%. CONCLUSIONS: Split-liver transplantation is achieving graft and patient
survival rates similar to that of whole liver transplantation despite a higher
incidence of complications, which could become less frequent as experience is
gained with this procedure. A wider acceptance of split-liver transplantation
could markedly increase the supply of liver graft