Feasibility and limits of split liver transplantation from pediatric donors: an italian multicenter experience

Ann Surg. 2006 Nov;244(5):805-14. doi: 10.1097/01.sla.0000218076.85213.60.


Objective: To report the results of a multicenter experience of split liver transplantation (SLT) with pediatric donors.

Summary background data: There are no reports in the literature regarding pediatric liver splitting; further; the use of donors weighing <40 kg for SLT is currently not recommended.

Methods: From 1997 to 2004, 43 conventional split liver procedures from donors aged <15 years were performed. Nineteen donors weighing < or =40 kg and 24 weighing >40 kg were used. Dimensional matching was based on donor-to-recipient weight ratio (DRWR) for left lateral segment (LLS) and on estimated graft-to-recipient weight ratio (eGRWR) for extended right grafts (ERG). In 3 cases, no recipient was found for an ERG. The celiac trunk was retained with the LLS in all but 1 case. Forty LLSs were transplanted into 39 children, while 39 ERGs were transplanted into 11 children and 28 adults.

Results: Two-year patient and graft survival rates were not significantly different between recipients of donors < or =40 kg and >40 kg, between pediatric and adult recipients, and between recipients of LLSs and ERGs. Vascular complication rates were 12% in the < or =40 kg donor group and 6% in the >40 kg donor group (P = not significant). There were no differences in the incidence of other complications. Donor ICU stay >3 days and the use of an interposition arterial graft were associated with an increased risk of graft loss and arterial complications, respectively.

Conclusions: Splitting of pediatric liver grafts is an effective strategy to increase organ availability, but a cautious evaluation of the use of donors < or =40 kg is necessary. Prolonged donor ICU stay is associated with poorer outcomes. The maintenance of the celiac trunk with LLS does not seem detrimental for right-sided grafts, whereas the use of interposition grafts for arterial reconstruction should be avoided.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Body Weight
  • Child
  • Child, Preschool
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Graft Survival
  • Humans
  • Infant
  • Infant, Newborn
  • Italy / epidemiology
  • Liver Diseases / mortality
  • Liver Diseases / surgery*
  • Liver Transplantation / methods*
  • Liver Transplantation / mortality
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Rate
  • Tissue Donors*
  • Treatment Outcome