  
Outcome of split-liver transplantation better with right graft than with left
Last Updated: 2001-04-10 17:03:53 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) - Split-liver transplantation is technically feasible, according to researchers in France, although survival rates are better for recipients of the larger right graft than for recipients of left-liver transplants.
Dr. Daniel M. Azoulay, of Hopital Paul Brousse in Villejuif, and a multicenter team examined the outcomes of 34 adults who received split-liver transplants and 88 who received whole-liver transplants between July 1993 to December 1999. Thirty livers were split ex situ and four were split by in situ procedures. In all cases, the donor-recipient match was "optimal," the researchers say in the April issue of Annals of Surgery.
Patient and graft survival rates were similar between recipients of whole-liver transplants and recipients of right-liver transplants. Left-liver transplants were associated with higher levels of graft failure from primary nonfunction, and therefore with lower patient and graft survival rates.
Specifically, the 2-year survival rate among patients with whole-, right- or left-liver transplants was 88%, 74% and 64%, respectively. The corresponding rates of graft survival were 85%, 74% and 43%.
"The principal pretransplantation factors influencing patient survival were graft steatosis and the hospital status of the recipient," the authors say. "The two principal factors affecting graft survival were graft steatosis and a graft-to-recipient body weight ratio of less than 1%."
Dr. Azoulay and his associates believe that "there are no medical or ethical obstacles to more widespread use" of split-liver transplantation. They suggest that outcome could be improved by "rigid selection criteria for donors and recipients, particularly for the smaller left graft, and possibly also...in situ splitting in cadaver donors."
Ann Surg 2001;233:565-574.
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