Cadaveric organ splitting results from improved understanding of surgical anatomy of the liver and is a possible mechanism to expand the organ pool. In this study we report the first series of split liver transplantation (SLT) performed in Shiraz transplant unit. From June 2006 till June 2008, 17 pairs of SLT (70.6% ex-situ, 29.4% in-situ) were performed in our institute. Mean age of the donors(32 male, 2 female) were 23.15±9 y/o and all of them had been stable at the time of harvesting according to vital signs, liver function tests, electrolytes and urine output. The decision on splitting was taken by the surgical team according to donor status and urgency of the recipients’ status. Mean age of the pediatric recipients (8 males, 11 females) were 5.18±4.62 and mean age of the adults (8 males, 7 females) were 26.60±7.92 y/o. The main indications were biliary atresia (17.6%) followed by Wilson disease (14.7%), cryptogenic cirrhosis (14.7%), sclerosing cholangitis (14.7%) and progressive familial intrahepatic cholestasis (14.7%). All of the patients were in Child C, 28% of them had preoperative encephalopathy and 1 of them was a case of retransplantation because of hepatic artery thrombosis of previous graft. The mean cold ischemic time was a 1.8±0.8 hour for in situ and 8.2±4.6 hours for ex situ splitting. Left lateral segment and left lobe were used in 6 and 11 cases respectively. All of the procedures were done by piggyback technique. In-hospital mortality for pediatric and adult group was 68.4% and 26.7% respectively. Primary graft nonfunction (52.9%), vascular complications (29.4%), sepsis (11.8%), and biliary complications (5.9%) were the main causes of this mortality.Experience of our center indicates that SLT has a high rate of mortality and morbidity and we must use more effort to decrease this.
Volume : 6
Issue : 4
Pages : 62
Shiraz Transplant Center, Namazi Hospital and Transplantion Research Center, Shiraz University of Medical Sciences, Shiraz, Iran