Outcomes with split liver transplantation in 106 recipients: The University of California, San Francisco, experience from 1993 to 2010

Parsia A. Vagefi, Justin Parekh, Nancy L. Ascher, John P. Roberts, Chris E. Freise

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Abstract

Background: Split liver transplantation (SLT) allows for expansion of the deceased donor pool. Objectives: To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients. Design: Single-center retrospective review (September 18, 1993, to July 1, 2010). Setting: University medical center. Patients: One hundred six SLT recipients. Main Outcome Measures: Postoperative graft and patient survival and postoperative complications. Results: In adults, 1-, 5-, and 10-year overall patient survival was 93%, 77%, and 73%, respectively; overall graft survival was 89%, 76%, and 65%, respectively; ex vivo split patient survival was 93%, 85%, and 74%, respectively; and ex vivo graft survival was 86%, 77%, and 63%, respectively. In situ split patient and graft survival was 94% at 1 year and 75% at 5 years. Postoperative complications included biliary (29%), vascular (11%), unplanned reexploratory surgery (11%), incisional hernia (8%), small-for-size syndrome (n=1), need for shunt at the time of SLT (n=1), and primary nonfunction (n=1). In children, 1-, 5-, and 10-year overall patient survival was 84%, 75%, and 69%, respectively; overall graft survival was 77%, 63%, and 57%, respectively; ex vivo split patient survival was 83%, 73%, and 73%, respectively; and ex vivo graft survival was 75%, 59%, and 59%, respectively. In situ split patient and graft survival was 86% at 1 and 5 years. Postoperative complications included biliary (40%), vascular (26%), and primary nonfunction (n=1). Conclusions: Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.

Original languageEnglish (US)
Pages (from-to)1052-1059
Number of pages8
JournalArchives of Surgery
Volume146
Issue number9
DOIs
StatePublished - Sep 1 2011

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San Francisco
Liver Transplantation
Graft Survival
Survival
Blood Vessels
Tissue Donors
Outcome Assessment (Health Care)
Pediatrics
Morbidity

ASJC Scopus subject areas

  • Surgery

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Outcomes with split liver transplantation in 106 recipients : The University of California, San Francisco, experience from 1993 to 2010. / Vagefi, Parsia A.; Parekh, Justin; Ascher, Nancy L.; Roberts, John P.; Freise, Chris E.

In: Archives of Surgery, Vol. 146, No. 9, 01.09.2011, p. 1052-1059.

Research output: Contribution to journalArticle

Vagefi, Parsia A. ; Parekh, Justin ; Ascher, Nancy L. ; Roberts, John P. ; Freise, Chris E. / Outcomes with split liver transplantation in 106 recipients : The University of California, San Francisco, experience from 1993 to 2010. In: Archives of Surgery. 2011 ; Vol. 146, No. 9. pp. 1052-1059.
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title = "Outcomes with split liver transplantation in 106 recipients: The University of California, San Francisco, experience from 1993 to 2010",
abstract = "Background: Split liver transplantation (SLT) allows for expansion of the deceased donor pool. Objectives: To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients. Design: Single-center retrospective review (September 18, 1993, to July 1, 2010). Setting: University medical center. Patients: One hundred six SLT recipients. Main Outcome Measures: Postoperative graft and patient survival and postoperative complications. Results: In adults, 1-, 5-, and 10-year overall patient survival was 93{\%}, 77{\%}, and 73{\%}, respectively; overall graft survival was 89{\%}, 76{\%}, and 65{\%}, respectively; ex vivo split patient survival was 93{\%}, 85{\%}, and 74{\%}, respectively; and ex vivo graft survival was 86{\%}, 77{\%}, and 63{\%}, respectively. In situ split patient and graft survival was 94{\%} at 1 year and 75{\%} at 5 years. Postoperative complications included biliary (29{\%}), vascular (11{\%}), unplanned reexploratory surgery (11{\%}), incisional hernia (8{\%}), small-for-size syndrome (n=1), need for shunt at the time of SLT (n=1), and primary nonfunction (n=1). In children, 1-, 5-, and 10-year overall patient survival was 84{\%}, 75{\%}, and 69{\%}, respectively; overall graft survival was 77{\%}, 63{\%}, and 57{\%}, respectively; ex vivo split patient survival was 83{\%}, 73{\%}, and 73{\%}, respectively; and ex vivo graft survival was 75{\%}, 59{\%}, and 59{\%}, respectively. In situ split patient and graft survival was 86{\%} at 1 and 5 years. Postoperative complications included biliary (40{\%}), vascular (26{\%}), and primary nonfunction (n=1). Conclusions: Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.",
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AU - Vagefi, Parsia A.

AU - Parekh, Justin

AU - Ascher, Nancy L.

AU - Roberts, John P.

AU - Freise, Chris E.

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N2 - Background: Split liver transplantation (SLT) allows for expansion of the deceased donor pool. Objectives: To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients. Design: Single-center retrospective review (September 18, 1993, to July 1, 2010). Setting: University medical center. Patients: One hundred six SLT recipients. Main Outcome Measures: Postoperative graft and patient survival and postoperative complications. Results: In adults, 1-, 5-, and 10-year overall patient survival was 93%, 77%, and 73%, respectively; overall graft survival was 89%, 76%, and 65%, respectively; ex vivo split patient survival was 93%, 85%, and 74%, respectively; and ex vivo graft survival was 86%, 77%, and 63%, respectively. In situ split patient and graft survival was 94% at 1 year and 75% at 5 years. Postoperative complications included biliary (29%), vascular (11%), unplanned reexploratory surgery (11%), incisional hernia (8%), small-for-size syndrome (n=1), need for shunt at the time of SLT (n=1), and primary nonfunction (n=1). In children, 1-, 5-, and 10-year overall patient survival was 84%, 75%, and 69%, respectively; overall graft survival was 77%, 63%, and 57%, respectively; ex vivo split patient survival was 83%, 73%, and 73%, respectively; and ex vivo graft survival was 75%, 59%, and 59%, respectively. In situ split patient and graft survival was 86% at 1 and 5 years. Postoperative complications included biliary (40%), vascular (26%), and primary nonfunction (n=1). Conclusions: Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.

AB - Background: Split liver transplantation (SLT) allows for expansion of the deceased donor pool. Objectives: To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients. Design: Single-center retrospective review (September 18, 1993, to July 1, 2010). Setting: University medical center. Patients: One hundred six SLT recipients. Main Outcome Measures: Postoperative graft and patient survival and postoperative complications. Results: In adults, 1-, 5-, and 10-year overall patient survival was 93%, 77%, and 73%, respectively; overall graft survival was 89%, 76%, and 65%, respectively; ex vivo split patient survival was 93%, 85%, and 74%, respectively; and ex vivo graft survival was 86%, 77%, and 63%, respectively. In situ split patient and graft survival was 94% at 1 year and 75% at 5 years. Postoperative complications included biliary (29%), vascular (11%), unplanned reexploratory surgery (11%), incisional hernia (8%), small-for-size syndrome (n=1), need for shunt at the time of SLT (n=1), and primary nonfunction (n=1). In children, 1-, 5-, and 10-year overall patient survival was 84%, 75%, and 69%, respectively; overall graft survival was 77%, 63%, and 57%, respectively; ex vivo split patient survival was 83%, 73%, and 73%, respectively; and ex vivo graft survival was 75%, 59%, and 59%, respectively. In situ split patient and graft survival was 86% at 1 and 5 years. Postoperative complications included biliary (40%), vascular (26%), and primary nonfunction (n=1). Conclusions: Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.

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