Outcomes in adult recipients of right-sided liver grafts in split-liver procedures

Luca Viganò, Alexis Laurent, Claude Tayar, Jean Claude Merle, Jean Yves Lauzet, Monica Hurtova, Thomas Decaens, Christophe Duvoux, Daniel Cherqui

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background The split-liver technique provides a good left lateral graft in children, but its results in adults remain controversial. Methods: From 1992 to 2007, 37 patients received 38 cadaveric right-sided grafts. Donors and recipients were selected for good quality grafts and elective indications; the latter included a high proportion of tumour cases and primary sclerosing cholangitis. Grafts included 31 extended right grafts (ERGs; segments IV-VIII and I and the inferior vena cava [IVC]) and seven right grafts (RGs; segments V-VIII) including five without the IVC and middle hepatic vein (MHV). Results: Mortality was 5% (two patients). There were four retransplantations (11%) for arterial thrombosis (1), portal vein thrombosis (2) and primary non-function (1). The retransplantation rate was higher in RG than in ERG (three vs. one patient; P = 0.015). Of the five patients without MHV, three were retransplanted and one had small-for-size syndrome leading to late death. After a mean follow-up of 5 years, 1-, 3- and 5-year graft and patient survival rates were 84%, 80% and 71%, and 91%, 88% and 78%, respectively. One-year patient and graft survival rates after ERG transplantation were 96% and 92%, respectively. Conclusions: Split-liver transplantation is a safe alternative to whole organ transplantation when an ERG is carried out. Right graft is associated with increased risk of graft loss, especially if the MHV is omitted. Split-liver transplantation with an ERG offers excellent outcomes and should be encouraged when good quality grafts are available.

Original languageEnglish
Pages (from-to)195-203
Number of pages9
JournalHPB
Volume12
Issue number3
DOIs
Publication statusPublished - 2010

Fingerprint

Transplants
Liver
Hepatic Veins
Inferior Vena Cava
Graft Survival
Liver Transplantation
Thrombosis
Survival Rate
Sclerosing Cholangitis
Organ Transplantation
Portal Vein
Transplantation
Tissue Donors
Mortality
Neoplasms

Keywords

  • Extended right graft
  • Graft survival
  • Liver transplantation
  • Right graft
  • Split liver transplantation

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology
  • Medicine(all)

Cite this

Viganò, L., Laurent, A., Tayar, C., Merle, J. C., Lauzet, J. Y., Hurtova, M., ... Cherqui, D. (2010). Outcomes in adult recipients of right-sided liver grafts in split-liver procedures. HPB, 12(3), 195-203. https://doi.org/10.1111/j.1477-2574.2009.00147.x

Outcomes in adult recipients of right-sided liver grafts in split-liver procedures. / Viganò, Luca; Laurent, Alexis; Tayar, Claude; Merle, Jean Claude; Lauzet, Jean Yves; Hurtova, Monica; Decaens, Thomas; Duvoux, Christophe; Cherqui, Daniel.

In: HPB, Vol. 12, No. 3, 2010, p. 195-203.

Research output: Contribution to journalArticle

Viganò, L, Laurent, A, Tayar, C, Merle, JC, Lauzet, JY, Hurtova, M, Decaens, T, Duvoux, C & Cherqui, D 2010, 'Outcomes in adult recipients of right-sided liver grafts in split-liver procedures', HPB, vol. 12, no. 3, pp. 195-203. https://doi.org/10.1111/j.1477-2574.2009.00147.x
Viganò, Luca ; Laurent, Alexis ; Tayar, Claude ; Merle, Jean Claude ; Lauzet, Jean Yves ; Hurtova, Monica ; Decaens, Thomas ; Duvoux, Christophe ; Cherqui, Daniel. / Outcomes in adult recipients of right-sided liver grafts in split-liver procedures. In: HPB. 2010 ; Vol. 12, No. 3. pp. 195-203.
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AU - Tayar, Claude

AU - Merle, Jean Claude

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AU - Hurtova, Monica

AU - Decaens, Thomas

AU - Duvoux, Christophe

AU - Cherqui, Daniel

PY - 2010

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N2 - Background The split-liver technique provides a good left lateral graft in children, but its results in adults remain controversial. Methods: From 1992 to 2007, 37 patients received 38 cadaveric right-sided grafts. Donors and recipients were selected for good quality grafts and elective indications; the latter included a high proportion of tumour cases and primary sclerosing cholangitis. Grafts included 31 extended right grafts (ERGs; segments IV-VIII and I and the inferior vena cava [IVC]) and seven right grafts (RGs; segments V-VIII) including five without the IVC and middle hepatic vein (MHV). Results: Mortality was 5% (two patients). There were four retransplantations (11%) for arterial thrombosis (1), portal vein thrombosis (2) and primary non-function (1). The retransplantation rate was higher in RG than in ERG (three vs. one patient; P = 0.015). Of the five patients without MHV, three were retransplanted and one had small-for-size syndrome leading to late death. After a mean follow-up of 5 years, 1-, 3- and 5-year graft and patient survival rates were 84%, 80% and 71%, and 91%, 88% and 78%, respectively. One-year patient and graft survival rates after ERG transplantation were 96% and 92%, respectively. Conclusions: Split-liver transplantation is a safe alternative to whole organ transplantation when an ERG is carried out. Right graft is associated with increased risk of graft loss, especially if the MHV is omitted. Split-liver transplantation with an ERG offers excellent outcomes and should be encouraged when good quality grafts are available.

AB - Background The split-liver technique provides a good left lateral graft in children, but its results in adults remain controversial. Methods: From 1992 to 2007, 37 patients received 38 cadaveric right-sided grafts. Donors and recipients were selected for good quality grafts and elective indications; the latter included a high proportion of tumour cases and primary sclerosing cholangitis. Grafts included 31 extended right grafts (ERGs; segments IV-VIII and I and the inferior vena cava [IVC]) and seven right grafts (RGs; segments V-VIII) including five without the IVC and middle hepatic vein (MHV). Results: Mortality was 5% (two patients). There were four retransplantations (11%) for arterial thrombosis (1), portal vein thrombosis (2) and primary non-function (1). The retransplantation rate was higher in RG than in ERG (three vs. one patient; P = 0.015). Of the five patients without MHV, three were retransplanted and one had small-for-size syndrome leading to late death. After a mean follow-up of 5 years, 1-, 3- and 5-year graft and patient survival rates were 84%, 80% and 71%, and 91%, 88% and 78%, respectively. One-year patient and graft survival rates after ERG transplantation were 96% and 92%, respectively. Conclusions: Split-liver transplantation is a safe alternative to whole organ transplantation when an ERG is carried out. Right graft is associated with increased risk of graft loss, especially if the MHV is omitted. Split-liver transplantation with an ERG offers excellent outcomes and should be encouraged when good quality grafts are available.

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