LIVING LIVER DONORS AND TECHNIQUES

R. Valente¹, F. Dar¹, T. Cherian¹, W. Jassem², J. O'grady¹, K. Agarwal¹, V. Aluvihare¹, M. Heneghan¹, A. Suddle¹, H. Vilca melendez¹, A. Prachalias¹, P. Srinivasan¹, M. Rela², N. Heaton^2
1, Institute of Liver Studies, London/UNITED KINGDOM, ²Liver Transplantation, Institute of Liver Studies, London/UNITED KINGDOM

Body: Background Split liver transplantation is a valuable option in expanding the donor pool. The results of left lateral segment transplantation have been well documented in children. However, there is little available data on right lobe split transplantation (RLT). In the current study we report our single centre experience of ex-situ RLT in adult recipients. Methods We analyzed 3596 primary liver transplants performed between 1989 and 2009. Of these, 204 were right lobe liver grafts split ex-situ with systematic ablation of segment IV in adult recipients. Using a computerized algorithm, these RLT were pair matched with 2770 primary whole liver transplants (WLT) that were comparable in for all the following variables: period of transplantation, donor and recipient age, acute/elective presentation, Child Pugh class and cold ischaemia time. The matching procedure paired 115 RLT with 230 WLT. Patient and graft survival and other complications were analyzed. Survival rates were computed using the Kaplan Meier method and compared by Log Rank. The Fisher exact test was utilised for categorical variables, and the Mann-Whitney U test for continuous numeric data. Results The median follow up for the RLT and WLT was 84 months (range 0 to 197) and 80 months (range 0 to 176) respectively. Patient survival at 1, 3, 5 years in RLT was 91.3%, 91.3%, 85.8% and in WLT 87.3%, 83.4%, 84.9%. Graft survival at 1, 3, 5 yearsin RLT was 89.6%, 89.6%, 84.0% and in WLT 84.9%, 75.8%,78.0%. There was no significant difference in overall patient and graft survival between RLT and WLT. No significant difference was found between the 2 groups regarding biliary and vascular complications. Post-transplant laparotomies for bleeding occurred in 8 (7%) RLT and 13 (11.3%) WLT. Hepatic arterial thrombosis occurred in 7 (6.1%) RLT and 6 (5.2%) WLT, primary non function occurred in 4 (3.5%) RLT and 5 (4.3%) WLT. Biliary complications occurred in 10 (8.7%) RLT and 11 (9.6%) WLT. Among them bile leak occurred in8 (6.9%) RLT and 4 (3.5%) WLT, anastomotic strictures in 1 (0.9%) RLT and 6 (5.2%) WLT and complex complications in 1 case (0.9%) in each group. None of the biliary complications caused patient death or graft loss. Conclusion Ex situ right lobe split livers have the potential to be good allografts, as well as expand the donor pool. In the present series we have demonstrated RLT to have similar overall outcome to WLT.

Disclosure: All authors have declared no conflicts of interest.