Experience with split liver transplantation in Vall Hebron Hospital

Introduction: We report our experience with the split liver technique in adults and children. Methods: From October 1992 to November 2001, we performed 11 liver splittings and transplanted 22 patients, 11 adults and 11 children. Liver splitting was performed ex situ in all patients except one in whom a mixed technique was used. Splitting was performed in the mid-line on three occasions and to the right of the falciform ligament on eight occasions, depending on the size of the pediatric recipient. Results: 1) Pediatric recipients. The mean age was 3.4 years and mean weight was 13 kg. Five patients required livers urgently for fulminant hepatitis (n = 2), urgent retransplantation (n = 2) and Byler's disease (n = 1). Six patients had biliary atresia. Five patients, four who underwent emergency surgery and one who underwent elective surgery, died in the postoperative period. The causes were perioperative multiorgan failure in three patients who underwent transplantation in a critical condition, cerebral hemorrhage in one patient who died at day 2 on withdrawal of the intracranial pressure sensor, and multiorgan failure secondary to portal thrombosis and hemorrhage in one patient. The remaining six patients were discharged and are currently alive. Technical complications consisted of portal thrombosis in one patient and biliary complications in three patients. 2) Adult recipients. The mean age was 53 years. Six patients presented hepatocarcinoma; five had liver cirrhosis and one had fibrolamellar liver cell carcinoma. Four patients had liver cirrhosis of different etiology and one had undergone retransplantation due to hepatitis C recurrence. In all patients surgery was elective although 45% were Child class C. Two patients died in the postoperative period; one from irreversible shock following retransplantation due to primary failure of the split graft and the other from sepsis 55 days after presenting refractory ascites and renal insufficiency. Technical complications consisted of one partial thrombosis of the portal vein and four biliary complications. One-year survival was 83%. Conclusions: In our program, split liver transplantation enabled a further six children and five adults to undergo transplantation. The results in patients undergoing elective surgery (six children and 11 adults) were good with a 1-year survival of 82%. The results of emergency surgery in children were poor with a survival of 20% due to the seriousness of the patients' condition.