Zhao D, Xie QH, Fang TS, Zhang KJ, Tang JX, Yan X, Jin X, Xie LJ, Xie WG. How to apply ex-vivo split liver transplantation safely and feasibly: A three-step approach. World J Gastrointest Surg 2024; 16(6): 1691-1699 [PMID: 38983312 DOI: 10.4240/wjgs.v16.i6.1691]
Corresponding Author of This Article
Dong Zhao, MD, Chief Doctor, Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, No. 29 Bulan Road, Longgang District, Shenzhen 518112, Guangdong Province, China. zdong1233@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dong Zhao, Tai-Shi Fang, Kang-Jun Zhang, Jian-Xin Tang, Xu Yan, Xin Jin, Lin-Jie Xie, Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
Qiu-Hua Xie, Wen-Gui Xie, Department of Organ Procurement Organizations, Shenzhen Third People’s Hospital, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen 518112, Guangdong Province, China
Author contributions: Zhao D contributed to study conception, design, and administrative support; Xie QH, Fang TS, Zhang KJ, Xie WG, and Tang JX contributed to provision of the study materials or patients; Jin X and Xie LJ contributed to collection and assembly of the data; Zhao D and Tang JX contributed to data analysis and interpretation; all authors contributed to manuscript writing and final approval of the manuscript.
Supported bythe Shenzhen Science and Technology Research and Development Fund, No. JCYJ20220530163011026.
Institutional review board statement: The study was reviewed and approved by the ethics committee of Shenzhen Third People’s Hospital (Approval No. 2022-133).
Informed consent statement: All the patients provided informed consent before operation.
Conflict-of-interest statement: The authors have no conflicts of interests or disclosures to report.
Data sharing statement: If anyone needs relevant data, they can contact the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Zhao, MD, Chief Doctor, Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People’s Hospital, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, No. 29 Bulan Road, Longgang District, Shenzhen 518112, Guangdong Province, China. zdong1233@126.com
Received: February 26, 2024 Revised: May 1, 2024 Accepted: May 21, 2024 Published online: June 27, 2024 Processing time: 124 Days and 18.5 Hours
Abstract
BACKGROUND
Given the current organ shortage crisis, split liver transplantation (SLT) has emerged as a promising alternative for select end-stage liver disease patients.
AIM
To introduce an ex-vivo liver graft splitting approach and evaluate its safety and feasibility in SLT.
METHODS
A retrospective analysis was conducted on the liver transplantation data from cases performed at our center between April 1, 2022, and May 31, 2023. The study included 25 SLT cases and 81 whole liver transplantation (WLT) cases. Total ex-vivo liver splitting was employed for SLT graft procurement in three steps. Patient outcomes were determined, including liver function parameters, postoperative complications, and perioperative mortality. Group comparisons for categorical variables were performed using the χ²-test.
RESULTS
In the study, postoperative complications in the 25 SLT cases included hepatic artery thrombosis (n = 1) and pulmonary infections (n = 3), with no perioperative mortality. In contrast, among the 81 patients who underwent WLT, complications included perioperative mortality (n = 1), postoperative pulmonary infections (n = 8), abdominal infection (n = 1), hepatic artery thromboses (n = 3), portal vein thrombosis (n = 1), and intra-abdominal bleeding (n = 5). Comparative analysis demonstrated significant differences in alanine aminotransferase (176.0 vs 73.5, P = 0.000) and aspartate aminotransferase (AST) (42.0 vs 29.0, P = 0.004) at 1 wk postoperatively, and in total bilirubin (11.8 vs 20.8, P = 0.003) and AST (41.5 vs 26.0, P = 0.014) at 2 wk postoperatively. However, the overall incidence of complications was comparable between the two groups (P > 0.05).
CONCLUSION
Our findings suggest that the total ex-vivo liver graft splitting technique is a safe and feasible approach, especially under the expertise of an experienced transplant center. The approach developed by our center can serve as a valuable reference for other transplantation centers.
Core Tip: Split liver transplantation has become a routine procedure at many transplant centers, and there are currently two main approaches for the generation of split-liver allografts: In-situ splitting and ex-vivo splitting. While in-situ splitting, which involves liver division within the organ donor’s body before procurement, is the prevailing technique adopted by most transplant centers, the utilization of ex-vivo splitting, wherein the liver is divided after procurement, remains limited. Our findings suggest that the ex-vivo liver graft splitting technique is a safe and feasible approach, especially under the expertise of an experienced transplant center.
