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Ann Surg. 2014 Jan;259(1):157-65. doi: 10.1097/SLA.0b013e31827da6c9.

A prospective policy development to increase split-liver transplantation for 2 adult recipients: results of a 12-year multicenter collaborative study.

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*Department of General Surgery and Transplantation, Ospedale Niguarda Ca' Granda Hospital, Milan †Organ and Tissue Transplant Immunology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan ‡Department of Transplant Surgery, Ospedale San Martino, University of Genoa, Genoa §Chirurgia III, Centro trapianto di fegato e di intestino Ospedali Riuniti di Bergamo ¶Hepato-biliary Surgery and Liver Transplantation Unit, University of Padua, Padua ‖Liver Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan **Unit of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori Milan ††Liver Transplantation Unit, Azienda Ospedaliera-Universitaria Verona ‡‡Department of Surgical and Gastroenterological Sciences, University of Padua, Padua.



To analyze in a multicenter study the potential benefit of a new prospective policy development to increase split-liver procedures for 2 adult recipients.


Split-liver transplantation is an important means of overcoming organ shortages. Division of the donor liver for 1 adult and 1 pediatric recipient has reduced the mortality of children waiting for liver transplantation but the benefits or disadvantages to survival when the liver is divided for 2 adults (adult-to-adult split-liver transplant, AASLT) compared with recipients of a whole graft have not been fully investigated.


We developed a computerized algorithm in selected donors for 2 adult recipients and applied it prospectively over a 12-year period among 7 collaborative centers. Patient and graft outcomes of this cohort receiving AASLT either as full right grafts or full left grafts were analyzed and retrospectively compared with a matched cohort of adults who received a conventional whole-liver transplant (WLT). Univariate and multivariate analysis was done for selected clinical variables in the AASLT group to assess the impact on the patient outcome.


Sixty-four patients who received the AASLT had a high postoperative complication rate (64.1% grade III and IV) and a lower 5-year survival rate than recipients of a WLT (63.3% and 83.1%)


AASLT should be considered a surgical option for selected smaller-sized adults only in experimental clinical studies in experienced centers.

[Indexed for MEDLINE]

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