Transplantation 1992 Feb;53(2):387-91

The results of reduced-size liver transplantation, including split livers, in patients with end-stage liver disease

Langnas AN, Marujo WC, Inagaki M, Stratta RJ, Wood RP, Shaw BW Jr
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.

Abstract
We initiated a policy of using RSLT in critically ill patients in June of 1988.
Since that time we have performed 30 RSLTs in 29 patients, including 28 children
and 1 adult. The mean age of the children was 27 months (range 1 month to 10
years) with 14 (52%) being 1 year of age or less. The mean weight was 11.3 kg
(range 2-50 kg) with 20 being 10 kg or less. A total of 22 patients were in the
intensive care unit at the time of RSLT including 9 who were intubated. Of the
30 RSLTs, 23 were performed as a primary transplant while 7 were retransplants.
Indications for primary transplantation included biliary atresia (n = 11),
fulminant hepatic failure (n = 5), neonatal hepatitis (n = 4) and others (n =
3). The RSLT was used in retransplantation for primary nonfunction (n = 2),
hepatic artery thrombosis (n = 2), chronic rejection (n = 2), and herpetic
hepatitis (n = 1). The size reductions included 18 left lobes, 7 left lateral
segments, and 5 right lobes. This group includes the use of the split-liver
technique, which was applied to 10 patients (5 livers). The median
donor/recipient weight ratio for left lobe transplants was 2:1; left lateral
segments was 7.3:1; and right lobes 1.6:1. One year actuarial patient and graft
survivals were 68 and 65%, respectively, with a mean follow-up of 10.6 months.
The number of children dying awaiting transplantation has been significantly
reduced following the introduction of RSLD (3 of 115, 2.6% vs. 12 of 95, 13%; P
less than 0.02)