Liver Splitting for Two Adult Patients and Domino Liver Transplantation: The Paul Brousse Experience

Abstract

The reliability of splitting livers for transplantation into two adult recipients remains to be proven. The aim of this paper was to report our experience with such splitting in two adults. Ex situ and in situ splitting were performed in 15 and 2 cases, respectively, generating 34 grafts (30 transplanted in our center, 4 shipped to two partner centers). Cold ischemia time, intraoperative transfusion volume, and hospitalization stay were comparable for recipients of left and right grafts. Within 15 days of transplantation, liver function tests were significantly better for recipients of right grafts than for recipients of left grafts. Primary nonfunction occurred in three cases and was statistically related to the presence of a graft/body weight ratio (GBWR) of < 1% (P < 0.001). Eleven technical complications occurred in eight patients (morbidity rate 24%) including biliary stenosis (four cases); biliary leak and portal vein thrombosis (two cases each); hepatic artery stenosis, subphrenic abscess, and hemoperitoneum (one case each). These complications led to graft loss in three cases, with death resulting in two. After a mean follow-up of 34 months, 24 of 34 patients are alive with normal liver function tests. Actuarial 1-year patient and graft survival rates were, respectively, 80% and 74% for the whole series. Actuarial 1-year patient and graft survival rates for right and left grafts were not statistically different (72% vs. 87% and 72% vs. 76% respectively).