Ann Liver Transplant.  2022 Nov;2(2):132-138. 10.52604/alt.22.0018.

Experience of split liver transplantation from deceased marginal donor: eight adult recipients from four deceased donors

• You YK
• Chun J
• Choi Y
• Woo Y
• Ahn J
• Choi HJ

• KMID: 2560908
• DOI: http://doi.org/10.52604/alt.22.0018

Abstract

Background
Split liver transplantation has been explored as one of method to increase donor supply. Concerns about the complexity and increased risk of vascular and biliary complexity makes split liver transplantation stable so far. Technical complexity has been overcome in South Korea due to abundant experience of living donor liver transplantation. However, liver transplantation of full right and full left liver has not been popularized because of ambiguousness in allocation policy for adult split liver in Korea.
Methods
Four deceased marginal donor split liver procedures were performed for eight adult recipients in our institute since 2017.
Results
Three of four donors had elevated aspartate aminotransferase or alanine aminotransferase level beyond three times of reference range. One of them was 60 years old. Three splits were made in situ and one split procedure was carried out ex vivo. After splitting liver, all four right graft were allocated to patients of high model for end-stage liver disease score and the left grafts with main vascular structures were transplanted to sub-urgent waiting list individuals. Graft to recipient body weight ratio range for both right and left liver graft were 1.5 to 2.2 and 0.9 to 1.4 respectively. Cold ischemic time ranged from 59 minutes to 388 minutes. Graft liver function of all recipients recovered without remarkable events. One recipient of right liver graft died in 11 post-transplantation months due to aggravating preexisting myelofibrosis and one left liver recipient for liver re-transplantation of primary liver graft failure expired due to cerebral infarct on post-transplantation 21 days.
Conclusion
Split liver graft from selected deceased marginal donor graft to both adult recipients has the potential to expand donor pool.

Keyword

Marginal donor; Split liver transplantation; In situ split; Ex vivo split; Deceased donor