Split Liver Transplantation Workup

  • Author: David A Axelrod, MD, MBA; Chief Editor: Stuart M Greenstein, MD   more...
 
Updated: Mar 11, 2010
 

Laboratory Studies

  • The usual laboratory tests for a multiorgan deceased donor candidate are required, including blood typing, blood count determination, arterial blood gas analysis, basic metabolic panel, liver function tests, and hepatitis and HIV serology.
  • Blood cultures may be obtained to rule out infection in prolonged hospitalization.
  • Patients with positive serologic results for hepatitis or HIV are excluded from split-liver transplantation (SLT), although 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.
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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.
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Diagnostic Procedures

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

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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.

Specialty Editor Board

Casimir F Firlit, MD, PhD  Director of Reconstructive Urology, Department of Neuro-Urology and Fetal Urology, SSM Cardinal Glennon Children's Medical Center

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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.

Ron Shapiro, MD  Professor of Surgery, Robert J Corry Chair in Transplantation Surgery, 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: Brystol Meyer Squibb StemCell Data Monitoring Committee Consulting fee Review panel membership; Stem Cells, Inc Consulting fee Review panel membership; Up To Date contracted Author; Novartis Honoraria Consulting; Genentech/Valcyte Honoraria Consulting

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.

Additional Contributors

The authors and editor of eMedicine gratefully acknowledge the contributions of prior coauthor John C Magee, MD, to the development and writing of this article.

References

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

  2. Emond JC, Whitington PF, Thistlethwaite JR, Cherqui D, Alonso EA, Woodle IS, 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].

  3. Kim JS, Broering DC, Tustas RY, et al. Split liver transplantation: past, present and future. Pediatr Transplant. Dec 2004;8(6):644-8. [Medline].

  4. Bismuth H, Houssin D. Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery. Mar 1984;95(3):367-70. [Medline].

  5. 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].

  6. 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].

  7. Pichlmayr R, Ringe B, Gubernatis G, et al. Transplantation of a donor liver to 2 recipients (splitting transplantation)--a new method in the further development of segmental liver transplantation. Langenbecks Arch Chir. 1988;373(2):127-30. [Medline].

  8. Broelsch CE, Emond JC, Whitington PF, et al. Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg. Sep 1990;212(3):368-75; discussion 375-7. [Medline].

  9. Bismuth H, Morino M, Castaing D, et al. Emergency orthotopic liver transplantation in two patients using one donor liver. Br J Surg. Jul 1989;76(7):722-4. [Medline].

  10. 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].

  11. Azoulay D, Astarcioglu I, Bismuth H, et al. Split-liver transplantation. The Paul Brousse policy. Ann Surg. Dec 1996;224(6):737-46; discussion 746-8. [Medline].

  12. Kalayoglu M, D'Alessandro AM, Knechtle SJ, Hoffmann RM, Pirsch JD, Judd RH, et al. Preliminary experience with split liver transplantation. J Am Coll Surg. May 1996;182(5):381-7. [Medline].

  13. 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].

  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. Rela M, Vougas V, Muiesan P, Vilca-Melendez H, Smyrniotis V, Gibbs P, et al. Split liver transplantation: King's College Hospital experience. Ann Surg. Feb 1998;227(2):282-8. [Medline].

  16. 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].

  17. 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].

  18. 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].

  19. Axelrod DA, Caicedo JC, Iyer K, et al. Living donation does not improve outcome in reduced sized pediatric liver transplantation. Hepatology. 2005;42:453A.

  20. Humar A, Horn K, Kalis A, et al. Living donor and split-liver transplants in hepatitis C recipients: does liver regeneration increase the risk for recurrence?. Am J Transplant. Feb 2005;5(2):399-405. [Medline].

  21. 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].

  22. 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].

  23. 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].

  24. Merion RM, Rush SH, Dykstra DM, et al. Predicted lifetimes for adult and pediatric split liver versus adult whole liver transplant recipients. Am J Transplant. Nov 2004;4(11):1792-7. [Medline].

  25. 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].

  26. 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].

  27. Lee TC, Barshes NR, Washburn WK, et al. Split-liver transplantation using the left lateral segment: a collaborative sharing experience between two distant centers. Am J Transplant. Jul 2005;5(7):1646-51. [Medline].

  28. 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].

  29. 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].

  30. 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].

  31. Azoulay D, Castaing D, Adam R, et al. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann Surg. Apr 2001;233(4):565-74. [Medline].

  32. Apt Pl, Rapaport-Kelz R, Desai NM, et al. Survival among pediatric liver transplant recipients: impact of segmental grafts. Liver Transplantation. 2004;10:1287-93. [Medline].

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

  34. Otte JB. Is it right to develop living related liver transplantation? Do reduced and split livers not suffice to cover the needs?. Transpl Int. 1995;8(1):69-73. [Medline].

  35. Renz JF, Kin C, Kinkhabwala M, et al. Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation. Ann Surg. Oct 2005;242(4):556-63; discussion 563-5. [Medline].

  36. 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].

 
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