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KMID : 0365719990150010033
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Journal of Pusan Surgical Society
1999 Volume.15 No. 1 p.33 ~ p.53
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In Situ Split Liver Transplanatation
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Lee Byong-Wook
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Abstract
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Background: Liver transplantation is established as the definitive therapy for patients with end-stage liver disease. Despite its excellent results, expansion of liver transplantation is hampered by some obstacles, one and the major of which is the shortage of donor organs. During the competition for the limited numbers of organs, many patients inevitably experience deteriorations in physical condition and a significant proportion of them should meet their ends. To expand livers for transplantation, many innovative techniques were developed. These are transplants with size reduced or splitted cadaveric grafts, and a part of liver from live donor.
Methods: This review describes the stepwise progressions in techniques of liver transplantation from reduced
liver transplantation (RLT) to in situ split liver transplantation (SLT). Each technique was designed to overcome the shortcomings of its ancestor.
Results: To expand grafts for pediatric patients with end stage liver disease, RLT was developed. It was a great benefit to the pediatric candidates at the expense of grafts for adult patients, who suffered more from the shortage of organs. Living-related liver transplantation (LRT), which cannot use the donor cava, was a natural
extension of a variant of RLT, the partial liver transplantation, which use the extremely size-reduced graft by not including cava with left lateral segment graft. LRT shows off excellent results with its numerous. medical and social advantages, and lessens competition for the limited cadaveric donor pool. But there are still unresolved issues concerning the risks posed to healthy donors. Ex vivo split technique was designed to provj le two functioning graft from a whole adult cadaveric liver. But with its inherent pitfalls in split technique itself, the result of ex vivo SLT is unsatisfactory compared with others.. It cannot increase the number of grafts more than 30%, much less than expected. In situ SLT is the culmination ha of theallograftefromgheartbeating ex vivo SLT and LRD. By adopting technique from LRT t multiorgan donor, in situ split technique provides two grafts of optimal quality and increases the numbers of graft effectively.
Conclusion: In situ splitting provides two grafts of optimal quality 1 t reci ients it is the method of choice for that can be applied to the entire spectrum of transp an p expanding the cadaver donor pool.
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KEYWORD
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In Situ Split Technique, Donor Organ Shortage, Orthotopic Liver Transplantation
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