Split Liver Transplantation Workup

Updated: Apr 07, 2020
  • Author: Jonathan P Roach, MD; Chief Editor: Stuart M Greenstein, MD  more...
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Laboratory Studies

The usual laboratory tests for a multiorgan deceased donor candidate are required, including the following:

  • Blood typing
  • Blood count
  • Arterial blood gas analysis
  • Basic metabolic panel
  • Liver function tests
  • Hepatitis and HIV serology

In addition, blood cultures may be obtained to rule out infection in donor candidates who have undergone prolonged hospitalization.

Patients with positive serologic results for hepatitis or HIV are excluded from split-liver transplantation (SLT). However, organs positive for hepatitis C can be used for whole-organ transplantation.

Liver function test results must be less than three times 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 imaging studies are required for splitting the liver beyond 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 split-liver transplantations. When the degree of steatosis is questionable, percutaneous liver biopsy may be performed before organ recovery. Similarly, open liver biopsy can be performed at the time of recovery should the liver unexpectedly appear abnormal.


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.