eMedicine Specialties > Pediatrics: Surgery > Transplantation

Split Liver Transplantation: Workup

Author: David A Axelrod, MD, MBA, Assistant Professor of Surgery, Section Chief, Solid Organ Transplantation, Dartmouth-Hitchcock Medical Center
Coauthor(s): John C Magee, MD, Director of Pediatric Transplantation, Associate Professor of Surgery, Department of Transplant Surgery, University of Michigan Hospital
Contributor Information and Disclosures

Updated: Jul 10, 2006

Workup

Laboratory Studies

  • The usual laboratory tests for a multiorgan deceased donor candidate are required and including the following: blood typing, blood count determination, arterial blood gas analysis, basic metabolic panel, liver function tests, and hepatitis and HIV serology.
  • Blood cultures may be ordered to rule out infection in prolonged hospitalization.
  • Patients with positive serologic results for hepatitis or HIV are excluded from SLT, though organs positive for hepatitis C can be used for whole-organ transplantation.
  • Results of liver function tests are required to be less than 3 times of the reference-range values. Livers with questionable fatty infiltration should be examined with biopsy and not be used for splitting if clinically significant fatty infiltration is found.

Imaging Studies

  • No specific laboratory test and imaging studies are required for splitting the liver besides the usual deceased multiorgan donor workup.
  • Studies that may be required in the workup for living donors, such as Doppler ultrasonography, angiography, magnetic resonance cholangiography, or endoscopic retrograde cholangiopancreatography (ERCP), are not required, and the anatomy of the liver is identified during surgical dissection in the operating room.

Diagnostic Procedures

  • No diagnostic procedures are routinely performed for SLTs.
  • When the degree of steatosis is questionable, percutaneous liver biopsy may be performed before organ recovery.

Histologic Findings

The presence of macrosteatosis in the liver biopsy sample increases the risk of primary nonfunction and injury due to ischemia reperfusion injury. Macrosteatosis is identified as large vesicles with the cytoplasm of the hepatocytes.

More on Split Liver Transplantation

Overview: Split Liver Transplantation
Workup: Split Liver Transplantation
Treatment: Split Liver Transplantation
Follow-up: Split Liver Transplantation
References
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References

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  8. Broelsch CE, Whitington PF, Emond JC, et al. Liver transplantation in children from living related donors. Surgical techniques and results. Ann Surg. Oct 1991;214(4):428-37; discussion 437-9. [Medline]. [Full Text].

  9. Busuttil RW, Farmer DG, Yersiz H, et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Ann Surg. Jun 2005;241(6):905-16; discussion 916-8. [Medline].

  10. Emond JC, Whitington PF, Thistlethwaite JR, et al. Transplantation of two patients with one liver. Analysis of a preliminary experience with ''split-liver'' grafting. Ann Surg. Jul 1990;212(1):14-22. [Medline].

  11. Emond JC, Freeman RB, Renz JF, et al. Optimizing the use of donated cadaver livers: analysis and policy development to increase the application of split-liver transplantation. Liver Transpl. Oct 2002;8(10):863-72. [Medline].

  12. Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. Apr 2006;6(4):783-90. [Medline].

  13. Ghobrial RM, Yersiz H, Farmer DG, et al. Predictors of survival after In vivo split liver transplantation: analysis of 110 consecutive patients. Ann Surg. Sep 2000;232(3):312-23. [Medline].

  14. Goss JA, Yersiz H, Shackleton CR, et al. In situ splitting of the cadaveric liver for transplantation. Transplantation. Sep 27 1997;64(6):871-7. [Medline].

  15. Gridelli B, Spada M, Petz W, et al. Split-liver transplantation eliminates the need for living-donor liver transplantation in children with end-stage cholestatic liver disease. Transplantation. Apr 27 2003;75(8):1197-203. [Medline].

  16. Gundlach M, Broering D, Topp S, et al. Split-cava technique: liver splitting for two adult recipients. Liver Transpl. Nov 2000;6(6):703-6. [Medline].

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  26. Roberts JP, Hulbert-Shearon TE, Merion RM, et al. Influence of graft type on outcomes after pediatric liver transplantation. Am J Transplant. Mar 2004;4(3):373-7. [Medline].

  27. Rogiers X, Malago M, Gawad K, et al. In situ splitting of cadaveric livers. The ultimate expansion of a limited donor pool. Ann Surg. Sep 1996;224(3):331-9; discussion 339-41. [Medline].

  28. Rogiers X, Malago M, Habib N, et al. In situ splitting of the liver in the heart-beating cadaveric organ donor for transplantation in two recipients. Transplantation. Apr 27 1995;59(8):1081-3. [Medline].

  29. Shaw BW Jr, Wood RP, Stratta RJ, et al. Management of arterial anomalies encountered in split-liver transplantation. Transplant Proc. Apr 1990;22(2):420-2. [Medline].

  30. Sommacale D, Farges O, Ettorre GM, et al. In situ split liver transplantation for two adult recipients. Transplantation. Mar 15 2000;69(5):1005-7. [Medline].

  31. Strong RW, Lynch SV, Ong TH, et al. Successful liver transplantation from a living donor to her son. N Engl J Med. May 24 1990;322(21):1505-7. [Medline].

  32. UNOS. United Network for Organ Sharing home page. Available at: http://www.unos.org/. [Full Text].

  33. Utterson EC, Shepherd RW, Sokol RJ, et al. Biliary atresia: clinical profiles, risk factors, and outcomes of 755 patients listed for liver transplantation. J Pediatr. Aug 2005;147(2):180-5. [Medline].

  34. Washburn K, Halff G, Mieles L, et al. Split-liver transplantation: results of statewide usage of the right trisegmental graft. Am J Transplant. Jul 2005;5(7):1652-9. [Medline].

  35. Yersiz H, Renz JF, Farmer DG, et al. One hundred in situ split-liver transplantations: a single-center experience. Ann Surg. Oct 2003;238(4):496-505; discussion 506-7. [Medline].

  36. de Ville de Goyet J. Split liver transplantation in Europe--1988 to 1993. Transplantation. May 27 1995;59(10):1371-6. [Medline].

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Further Reading

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Keywords

split liver transplantation, SLT, SPLIT, split-liver transplantation, split liver, liver transplantation, liver transplant, LT, orthotopic liver transplant, orthotopic liver transplantation, OLT, organ transplant, organ transplantation, hepatology, ascites, encephalopathy, cirrhosis, United Network for Organ Sharing, UNOS, liver donor, organ donor, rejection, reduced-size liver transplantation, living-donor liver transplantation, cadaveric donors

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Contributor Information and Disclosures

Author

David A Axelrod, MD, MBA, Assistant Professor of Surgery, Section Chief, Solid Organ Transplantation, Dartmouth-Hitchcock Medical Center
David A Axelrod, MD, MBA is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, and New Hampshire Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

John C Magee, MD, Director of Pediatric Transplantation, Associate Professor of Surgery, Department of Transplant Surgery, University of Michigan Hospital
Disclosure: Nothing to disclose.

Medical Editor

Casimir F Firlit, MD, PhD, Consulting Staff, Department of Urology, Cardinal Glennon Children's Hospital
Casimir F Firlit, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Society of Transplant Surgeons, American Urological Association, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Steve Dunn, MD, Chief, Solid Organ Transplantation, Department of Surgery, Alfred I DuPont Hospital for Children at Wilmington
Steve Dunn, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society of Transplant Surgeons, American Society of Transplantation, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Ron Shapiro, MD, Professor of Surgery, University of Pittsburgh; Director, Kidney, Pancreas, and Islet Transplantation, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center
Ron Shapiro, MD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, Association for Academic Surgery, Central Surgical Association, and Society of University Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Stuart M Greenstein, MD, Professor of Surgery, Albert Einstein College of Medicine; Consulting Surgeon, Department of Surgery, Division of Transplantation, Montefiore Medical Center
Stuart M Greenstein, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, International College of Surgeons, Medical Society of New Jersey, National Kidney Foundation, New York Academy of Sciences, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

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