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Hemiliver grafts produced successful outcomes, survival in split liver transplantations

Split liver transplantation yielded strong survival rates for at least 5 years, according to results from a recent study.

Koji Hashimoto, MD, PhD, department of general surgery, Digestive Disease Institute at Cleveland Clinic, and colleagues performed a retrospective review of split liver transplantations (SLT) performed at the clinic between April 2004 and June 2012. There were 1,089 liver transplantations conducted, including 48 SLT with 11 left lobes, 15 right lobes, 16 right trisegments and six left lateral segments.

Koji Hashimoto

After exclusions, researchers evaluated 10 left lobes and 15 right lobes for use in adult-size recipients. The data then were compared with results from a control group of 121 deceased, matched whole liver donors. Sixteen deceased donors yielded 32 hemiliver grafts; 25 were used for recipients at Cleveland Clinic, six were used at other centers and one was discarded.

Three-month, 1-year and 5-year patient survival rates were 96%, 88% and 88% in hemiliver grafts vs. 97.5%, 95% and 86.5% in whole liver grafts, respectively. Five-year graft survival rates were 80% for SLT vs. 81.5% for whole liver grafts.

Among hemiliver SLT, patient survival rates were better with right lobes than left lobes, including 93.3% vs. 80% at 5 years. Hemiliver recipients with severe portal hypertension had a greater graft-to-recipient weight ratio compared with those without it (1.96% vs. 1.4%, P<.05). Secondary recipients of leftover grafts did not display increased surgical complications (P=.43) or graft failure (P=.99) compared with primary recipients. Overall biliary complications were greater among hemiliver recipients compared with whole liver recipients (32% vs. 10.7%, P=.01).

“The split liver procedure helps with the shortage of organs — we can help two patients with one donor,” Hashimoto told Healio.com/Hepatology. “The smaller recipients on the transplant waiting list can be saved with a split liver as the split liver can be a better size match for a smaller recipient.

“This study shows that the patient outcome of a split liver transplantation is similar to a regular whole liver transplant procedure, and the long-term survival rate is the same for both split liver and whole liver transplant procedures.”

Disclosure: The researchers report no relevant financial disclosures.