Skip to main content

Full-Left Full-Right Split Liver Transplantation

  • Chapter

Part of the book series: Updates in Surgery ((UPDATESSURG))

Abstract

Full-left full-right split liver transplantation (FLFR SLT) is the division of a deceased donor liver into two similarly sized grafts and the subsequent transplantation of each of them into two adult-sized recipients. It may be considered an evolution from conventional SLT aiming at expanding the number of adult transplants and providing otherwise hardly available size-matched grafts for large children and adolescents. Its development has been supported by both growing experience in adult-to-adult living donor liver transplantation (LDLT) and advances in resectional liver surgery. Controversial outcomes have been reported so far, but most of the largest series worldwide have shown comparable results to those achieved by the most common approaches, namely whole liver transplantation (WLT) in Europe and the United States and LDLT in Asia. Actually, FLFR SLT is extremely demanding and its possible success is multifactorial. Not only optimal organs from the best donors should be used, but the most favorable donor-to-recipient matching should be pursued. Moreover, FLFR SLT requires high levels of technical skills and expertise in liver transplantation, usually typical of high-volume transplant and hepatobiliary surgery centers. Finally, a split liver-oriented allocation policy encouraging graft sharing appears crucial for its implementation. So, in the presence of the above-mentioned conditions, FLFR SLT may become a safe and effective strategy to increase the number of adult transplants and to facilitate transplantation of large children and adolescents.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Bismuth H, Morino M, Castaing D, et al. Emergency orthotopic liver transplantation in two patients using one donor liver. Br J Surg. 1989;76:722–4.

    Article  CAS  Google Scholar 

  2. Colledan M, Andorno E, Valente U, et al. A new splitting technique for liver grafts. Lancet. 1999;353:1763.

    Article  CAS  Google Scholar 

  3. Colledan M. Split liver transplantation: techniques and results. Transplant Rev. 2005;19:221–31.

    Article  Google Scholar 

  4. Broering D, Schulte am Esch J II, Fischer L, Rogiers X. Split liver transplantation. HPB (Oxford). 2004;6:76–82.

    Article  CAS  Google Scholar 

  5. Hong JC, Yersiz H, Busuttil RW. Where are we today in split liver transplantation? Curr Opin Organ Transplant. 2011;16:269–73.

    Article  Google Scholar 

  6. Lauterio A, Di Sandro S, Concone G, et al. Current status and perspectives in split liver transplantation. World J Gastroenterol. 2015;21:11003–15.

    Article  CAS  Google Scholar 

  7. Hashimoto K, Fujiki M, Quintini C, et al. Split liver transplantation in adults. World J Gastroenterol. 2016;22:7500–6.

    Article  Google Scholar 

  8. Azoulay D, Castaing D, Adam R, et al. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann Surg. 2001;233:565–74.

    Article  CAS  Google Scholar 

  9. Zambelli M, Andorno E, De Carlis L, et al. Full-right-full-left split liver transplantation: the retrospective analysis of an early multicenter experience including graft sharing. Am J Transplant. 2012;12:2198–210.

    Article  CAS  Google Scholar 

  10. Hill M, Hughes M, Jie T, et al. Graft weight/recipient weight ratio: how well does it predict outcome after partial liver transplants? Liver Transpl. 2009;15:1056–62.

    Article  Google Scholar 

  11. Broering D, Wilms C, Lenk C, et al. Technical refinements and results in full-right full-left splitting of the deceased donor liver. Ann Surg. 2005;242:802–13.

    Article  Google Scholar 

  12. Gundlach M, Broering D, Topp S, et al. Split-cava technique: liver splitting for two adult recipients. Liver Transpl. 2000;6:703–6.

    Article  CAS  Google Scholar 

  13. Broering D, Bok P, Mueller L, et al. Splitting of the middle hepatic vein in full-right full-left splitting of the liver. Liver Transpl. 2005;11:350–2.

    Article  Google Scholar 

  14. Strasberg S, Lowell J, Howard T. Reducing the shortage of donor livers: what would it take to reliably split livers for transplantation into two adult recipients? Liver Transpl Surg. 1999;5:437–50.

    Article  CAS  Google Scholar 

  15. Azoulay D, Marin-Hargreaves G, Castaing D, Bismuth H. Ex situ splitting of the liver: the versatile Paul Brousse technique. Arch Surg. 2001;136:956–61.

    Article  CAS  Google Scholar 

  16. Hsu SL, Chen TY, Huang TL, et al. Left-sided gallbladder: its clinical significance and imaging presentations. World J Gastroenterol. 2007;13:6404–9.

    Article  Google Scholar 

  17. Belghiti J, Guevara OA, Noun R, et al. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193:109–11.

    Article  CAS  Google Scholar 

  18. Zimmerman A, Flahive J, Hertl M, et al. Outcomes of full-right-full-left split liver transplantation in adults in the USA: a propensity-score analysis. Int J Organ Transplant Med. 2016;7:69–76.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Adham M, Dumortier J, Abdelaal A, et al. Does middle hepatic vein omission in a right split graft affect the outcome of liver transplantation? A comparative study of right split livers with and without the middle hepatic vein. Liver Transpl. 2007;13:829–37.

    Article  Google Scholar 

  20. Sommacale D, Farges O, Ettorre GM, et al. In situ split liver transplantation for two adult recipients. Transplantation. 2000;69:1005–7.

    Article  CAS  Google Scholar 

  21. Cescon M, Grazi G, Ravaioli M, et al. Conventional split liver transplantation for two adult recipients: a recent experience in a single European center. Transplantation. 2009;88:1117–22.

    Article  Google Scholar 

  22. Viganò L, Laurent A, Tayar C, et al. Outcomes in adult recipients of right-sided liver grafts in split-liver procedures. HPB (Oxford). 2010;12:195–203.

    Article  Google Scholar 

  23. Herden U, Fischer L, Sterneck M, et al. Long-term follow-up after full-split liver transplantation and its applicability in the recent transplant era. Clin Transpl. 2018;32:e13205. https://doi.org/10.1111/ctr.13205.

    Article  Google Scholar 

  24. Patil N, Goyal N, Pareek S, et al. In situ splitting of the cadaver liver for two adult recipients by LDLT technique. J Clin Exp Hepatol. 2017;7:179–83.

    Article  Google Scholar 

  25. Lee WC, Chan KM, Chou HS, et al. Feasibility of split liver transplantation for 2 adults in the model of end-stage liver disease era. Ann Surg. 2013;258:306–11.

    Article  Google Scholar 

  26. Fan ST, Lo CM, Liu CL, et al. Split liver transplantation for two adult recipients. Hepato-Gastroenterology. 2003;50:231–4.

    PubMed  Google Scholar 

  27. Chakravarty KD, Chan KM, Wu TJ, et al. Split-liver transplantation in 2 adults: significance of caudate lobe outflow reconstruction in left lobe recipient: case report. Transplant Proc. 2009;41:3937–40.

    Article  CAS  Google Scholar 

  28. Humar A, Beissel J, Crotteau S, et al. Whole liver versus split liver versus living donor in the adult recipient: an analysis of outcomes by graft type. Transplantation. 2008;85:1420–4.

    Article  Google Scholar 

  29. Hashimoto K, Quintini C, Aucejo FN, et al. Split liver transplantation using hemiliver graft in the MELD era: a single center experience in the United States. Am J Transplant. 2014;14:2072–80.

    Article  CAS  Google Scholar 

  30. Cardillo M, De Fazio N, Pedotti P, et al. Split and whole liver transplantation outcomes: a comparative cohort study. Liver Transpl. 2006;12:402–10.

    Article  Google Scholar 

  31. Giacomoni A, Lauterio A, Donadon M, et al. Should we still offer split-liver transplantation for two adult recipients? A retrospective study of our experience. Liver Transpl. 2008;14:999–1006.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michele Colledan .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Cite this chapter

Camagni, S., Colledan, M. (2020). Full-Left Full-Right Split Liver Transplantation. In: Cillo, U., De Carlis, L. (eds) Liver Transplantation and Hepatobiliary Surgery. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19762-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-19762-9_12

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19761-2

  • Online ISBN: 978-3-030-19762-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics