How to apply ex-vivo split liver transplantation safely and feasibly: A three-step approach  

作　　者：Dong Zhao Qiu-Hua Xie Tai-Shi Fang Kang-Jun Zhang Jian-Xin Tang Xu Yan Xin Jin Lin-Jie Xie Wen-Gui Xie 

机构地区：[1]Department of Liver Surgery and Organ Transplantation Center,Shenzhen Third People’s Hospital,The Second Affiliated Hospital,School of Medicine,Southern University of Science and Technology,Shenzhen 518112,Guangdong Province,China [2]Department of Organ Procurement Organizations,Shenzhen Third People’s Hospital,The Second Affiliated Hospital,School of Medicine,Southern University of Science and Technology,Shenzhen 518112,Guangdong Province,China

出　　处：《World Journal of Gastrointestinal Surgery》2024年第6期1691-1699,共9页世界胃肠外科杂志（英文版）（电子版）

基　　金：Supported by the Shenzhen Science and Technology Research and Development Fund,No.JCYJ20220530163011026.

摘　　要：BACKGROUND Given the current organ shortage crisis,split liver transplantation(SLT)has emerged as a promising alternative for select end-stage liver disease patients.AIM To introduce an ex-vivo liver graft splitting approach and evaluate its safety and feasibility in SLT.METHODS A retrospective analysis was conducted on the liver transplantation data from cases performed at our center between April 1,2022,and May 31,2023.The study included 25 SLT cases and 81 whole liver transplantation(WLT)cases.Total ex-vivo liver splitting was employed for SLT graft procurement in three steps.Patient outcomes were determined,including liver function parameters,postoperative complications,and perioperative mortality.Group comparisons for categorical variables were performed using theχ²-test.RESULTS In the study,postoperative complications in the 25 SLT cases included hepatic artery thrombosis(n=1)and pulmonary infections(n=3),with no perioperative mortality.In contrast,among the 81 patients who underwent WLT,complications included perioperative mortality(n=1),postoperative pulmonary infections(n=8),abdominal infection(n=1),hepatic artery thromboses(n=3),portal vein thrombosis(n=1),and intra-abdominal bleeding(n=5).Comparative analysis demonstrated significant differences in alanine aminotransferase(176.0 vs 73.5,P=0.000)and aspartate aminotransferase(AST)(42.0 vs 29.0,P=0.004)at 1 wk postoperatively,and in total bilirubin(11.8 vs 20.8,P=0.003)and AST(41.5 vs 26.0,P=0.014)at 2 wk postoperatively.However,the overall incidence of complications was comparable between the two groups(P>0.05).CONCLUSION Our findings suggest that the total ex-vivo liver graft splitting technique is a safe and feasible approach,especially under the expertise of an experienced transplant center.The approach developed by our center can serve as a valuable reference for other transplantation centers.

关 键 词：Split liver transplantation TRANSPLANTATION Liver splitting EX-VIVO IN-SITU 

分 类 号：R657.3[医药卫生—外科学]