Increased use of split-liver transplants can trim waiting lists
Tuesday, July 22, 2014
In the United States, transplant lists typically have about 16,000 people waiting for new livers. Each year, 10 percent of that list — 1,600 patients — die before they are chosen.
Recent research at the Cleveland Clinic found that a technique called a split-liver transplant has the same survival rate after five years compared to that of whole-liver surgery (80 percent for split-liver transplants and 81.5 percent for whole-liver transplants).
"The main purpose of the procedure is to ... increase the number of transplants," Dr. Koji Hashimoto, a transplant surgeon at the Cleveland Clinic, told Fox News. "The important thing is the liver is the only organ in the body that can regenerate — if you split the liver into two pieces, these pieces can regenerate, and the size of the liver goes back to normal. This is a very unique organ."
Livers have two lobes, one lobe is about 60 to 65 percent of the size of a full adult liver, and the other lobe is 35 to 40 percent of the size of an adult liver. Split-liver donors can only be cadavers, as the entire liver has to be removed.
When whole-liver transplants are done, patient size is a factor in who gets the life-saving organ. If the liver comes from a full-sized male adult, the organ is too large for a child or a smaller adult. By using the split-liver technique, one adult and one child benefit from the donor.
Otherwise, if a child is at the top of the list and an adult is further down, the adult may bypass the child and get the whole liver due to its size. Giving the child the smaller lobe, and the adult the larger saves two lives instead of one.
Hashimoto explained that a split-liver transplant was first done at the Cleveland Clinic in 2004 but is rarely done. The technical aspects of the procedure are challenging because to split the liver properly, surgeons must also divide the blood vessels. Frequently, the surgery concerned with blood vessels requires the use of a surgical microscope. Splitting the liver takes place within the body of the donor.
Recently, an unusual split-liver procedure was performed in India, as both recipients were adults. This was the first time two adult liver recipients received a lobe each from a single donor. The donor was a 40-year-old adult male who was brain dead. One recipient was a 58-year-old male and the other was a 34-year-old male.
"Normally, when we do split-liver transplants, the thumb rule is that the right lobe goes to the adult and the left to a child," said Dr. Mohamed Rela, director of Global Health City's Institute for Liver Disease and Transplantation in India. "The results of giving the left lobe to an adult are very poor, because it is the smaller portion and may not be enough to sustain the person."
Rela added that the procedure is rare, and of about 6,000 transplants done at his hospital, only two or three were split-liver transplants.
Nevertheless, surgeons at the Cleveland Clinic are optimistic that greater use of the procedure will cut the amount of people waiting for a liver transplant and death rates of those on the waiting list.
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