Br J Surg 1993 Jan;80(1):75-80

Controlled liver splitting for transplantation in two recipients: technique
results and perspectives

Houssin D, Boillot O, Soubrane O, Couinaud C, Pitre J, Ozier Y, Devictor D,
Bernard O, Chapuis Y

Abstract
A technique of controlled liver splitting for transplantation in two recipients
is proposed, based on a full anatomical assessment of the graft including
arteriography and cholangiography on the back-table. Using eight livers, 16
patients received a graft: right liver (eight patients), left lobe (four) or
left liver (four). Twelve patients required urgent or very urgent
transplantation. Anatomical assessment of the graft demonstrated a portal
bifurcation in all cases, a common trunk of the left and middle hepatic veins in
five, a right biliary duplication in three and duplication of the left branch of
the middle hepatic artery in one. After revascularization of the graft, bleeding
was greater in patients with a right graft, particularly if the middle hepatic
vein had been ligated. The main postoperative complications were hepatic artery
thrombosis (four cases), biliary complications (four), portal vein thrombosis
(two), haematoma (two) and abscess (two). No primary non-function of the graft
was observed. The postoperative survival rate was 75 per cent. The four patients
in whom transplantation was not considered urgent are still alive. The immediate
survival rate of the grafts was 69 per cent. These results compare favourably
with those in the literature. In spite of the technical, logistical and ethical
problems raised by this technique, the results suggest that controlled liver
splitting for transplantation in two recipients may in the future significantly
improve the feasibility of liver transplantation