Abstract
Background
Split liver transplantation permits the transplant of two recipients using a single
donor liver. Liver splitting can be performed using the ex-vivo technique (more convenient),
or the in-situ technique (shorter cold ischaemic time). We aimed to develop a technique
for liver splitting during normothermic machine perfusion which combines the advantages
of both techniques and permits graft assessment prior to transplant.
Methods
Human livers declined for transplantation were perfused at 36 °C using a modified-commercial
perfusion machine. We developed a six-step method to split whole livers into left
lateral segment grafts and extended right grafts. Both partial livers were then perfused
on separate machines for individual assessment.
Results
Using our technique, 10 whole livers were successfully split during normothermic perfusion
resulting in 20 partial grafts. Apart from a single graft which failed due to a technical
error, all grafts survived for 24-h after splitting. Survival was demonstrated by
lactate clearance, bile production and synthesis of coagulation factors.
Conclusions
Liver splitting during normothermic machine perfusion has the potential to revolutionise
split liver transplantation. We describe a novel technique that reliably achieves
two grafts from a single donor liver. This raises the possibility of semi-elective
transplantation, and sophisticated graft assessment prior to implant.
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References
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Article info
Publication history
Published online: February 07, 2023
Accepted:
February 6,
2023
Received:
June 29,
2022
Publication stage
In Press Corrected ProofFootnotes
☆This paper was presented in part as an oral presentation at the 15th International Hepato-Pancreato Biliary Association (IHPBA) World Congress 2022 in New York, USA.
Identification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
