Split liver transplantation

SLT Split liver transplantation was developed as an alternative to OLT (118). The transplanted split should be around 1% of the body weight of the recipient. SLT has a higher complication rate than OLT. 

In split liver transplantation (SLT) (R. Pichlmayr et al., 1989), it is possible to transplant segments V-VIII, which are left over in OSLT, into an adult. (400) This means that two recipients can be supplied with one donor organ. The surgical splitting of the donor liver subjects the organ to considerable stress, and therefore its quality has to meet particularly high standards. (366,426)... 

Fig. 7.12. a A 9.6-year-old boy with a split liver transplantation (segments II and III). The patient was admitted to the paediatric intensive care because of severe haematemesis. The fluoroscopy image shows the TIPS catheter (arrow) placed within the portal vein. Multiple collateral vessels are shown (curved arrow), b After dilation of the puncture tract, two self-expandable stents (Smart diameter 9 mm.. Cordis, Johnson Johnson Medical N.V., Belgium) were placed. Angiography shows that the collaterals have collapsed and that the primary flow direction is through the TIPS, c Measurements of intravascular pressures shows the gradient to be 8 mm Hg, well below the threshold level of 15 mm Hg... 

Additionally, group 1 of this classification takes into account the proper variations of the common hepatic artery, and reminds the surgeons to take care of the small branches that originate directly from the proper hepatic artery, such as the segment IV artery, which is so important to preserve during split liver transplantation (Chaib et al. 2005 Saylisoy et al. 2005) (Fig. 20.5). 

Chaib E, Ribeiro MAF Jr, Saad WA, Gama-Rodrigues J (2005) The main hepatic anatomic variations for the purpose of split-liver transplantation. Transplant Proc 37 1063-1066... 

Neuhaus, P., Bechstein, W.O. Split liver/auxiliary hver transplantation for fulminant hepatic failure. Liver Transpl. Surg. 1997 3 355-361... 

Colledan, M., Andorno, E., Stalin, A., Lncianetti, A., Spada, M., Corno, V., Valente, U., Antonncd, A., Gridelll, B. Alternative split liver technique The equal size split. Transplant. Proc. 2001 33 1335-1336... 

Bile leak with resultant biloma and intra-abdominal infection with abscess formation can occur following reduced-sized, split and living related liver transplantation due to leak from the parenchymal cut-surface or inadvertent bile duct injury. Biliary reconstruction is by Roux-en-Y hepaticojejunostomy, and may involve two anastomoses at implantation of the left lateral segment at split or living related liver transplantation if segment II and III ducts are sepa-... 

Fig. 4.1.3. Ex vivo bench split of cadaveric liver graft into anatomical right and left lobes for transplantation...

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