Full-split liver transplantation. The first experience in Russian Federation
https://doi.org/10.16931/1995-5464.2021166-75
Abstract
Aim. To present the first successful full-split liver transplantation for two adults recipients in Russia.
Materials and methods. The first successful full-split liver transplantation for two adults in ex situ way in Russia was made on 26th of September 2014 in the Burnasyan Federal Medical Biophysical Center of FMBA. The deceased donor was inside UNOS, Lee. The GRWR index in both recipients was near 1. The first recipient had been in a waiting list for 1 year, the second for 4 months. Both recipients had got liver cirrhosis in terminal stage.
Results. The surgical procedure length was 650 and 660 min. The overall time of cold ischemia was 510 min. We observed a primary function of each graft. ISGLS B and Clavien-Dindo 3A biliary leak complications were observed in both recipients. Both patients were discharged after 33 and 34 days. Overall survival for this moment is 68 months.
Conclusion. Full-split liver transplantation for two adults in ex situ way seems to be a complicated procedure both from the technical and organizing points of view. It demanding good mastership and coordination between surgical team members. At the same time, that treatment method has to be spread widely to improve treatment of patients with end-stage cirrhosis results.
About the Authors
S. E. VoskanyanRussian Federation
Sergey E. Voskanyan – Doct. of Sci. (Med.), Corresponding Member of RAMS, Deputy Chief of Surgery – Head of the Center for Surgery and Transplantology, Head of the Department of Surgery with Courses of Oncology, Endoscopy, Surgical Pathology, Clinical Transplantology and Organ Donation of the Institute of Postgraduate Professional Education,
23, Marshala Novikova, Moscow, 123098
I. Yu. Kolyshev
Russian Federation
Ilya Yu. Kolyshev – Cand. of Sci. (Med.), Head of the Surgical Department №1, Center for New Surgical Technologies
23, Marshala Novikova, Moscow, 123098
M. V. Shabalin
Russian Federation
Maksim V. Shabalin – Cand. of Sci. (Med.), Surgeon of the Surgical Department, Center for Surgery and Transplantology
23, Marshala Novikova, Moscow, 123098
A. I. Artemyev
Russian Federation
Alexey I. Artemiev – Cand. of Sci. (Med.), Head of the Surgical Department №2, Center for Surgery and Transplantology
23, Marshala Novikova, Moscow, 123098
V. S. Rudakov
Russian Federation
Vladimir S. Rudakov – Cand. of Sci. (Med.), Surgeon of the Center for Surgery and Transplantology
23, Marshala Novikova, Moscow, 123098
A. P. Maltseva
Russian Federation
Anna P. Maltseva – Surgeon of the Center for Surgery and Transplantology
23, Marshala Novikova, Moscow, 123098
A. N. Bashkov
Russian Federation
Andrew N. Bashkov – Head of the Radiology Department
23, Marshala Novikova, Moscow, 123098
V. Е. Syutkin
Russian Federation
Vladimir E. Syutkin – Doct. of Sci. (Med.), Professor, Hepatologist of the Center for Surgery and Transplantology
23, Marshala Novikova, Moscow, 123098
К. К. Gubarev
Konstantin K. Gubarev – Cand. of Sci. (Med.), Head of the Coordination Center for Organ Donation
23, Marshala Novikova, Moscow, 123098
D. S. Svetlakova
Russian Federation
Daria S. Svetlakova – Surgeon of the Coordination Center for Organ Donation
23, Marshala Novikova, Moscow, 123098
References
1. Wong R.J., Singal A.K. Trends in liver disease etiology among adults awaiting liver transplantation in the United States. JAMA Net w Open. 2020; 3 (2): e1920294. https://doi.org/10.1001/jamanetworkopen.2019.20294
2. Husen P., Hornung J., Benko T., Klein C., Willuweit K., Buechter M., Hakan Saner F., Paul A., Treckmann J.W. Risk factors for high mortality on the liver transplant waiting list in times of organ shortage: a single-center analysis. Ann. Transplant. 2019; 24: 242–251. https://doi.org/10.12659/AOT.914246
3. Blok J.J., Putter H., Rogiers X., van Hoek B., Samuel U., Ringers J., Braat A.E. Combined effect of donor and recipient risk on outcome after liver transplantation: research of the Eurotransplant database. Eurotransplant Liver Intestine Advisory Committee. Liver Transpl. 2015; 21 (12): 1486–1493. https://doi.org/10.1002/lt.24308
4. Rodriguez P.S., Barritt IV A.S., Gerber D.A., Desai C.S. Liver transplant for unusually large polycystic liver disease: challenges and pitfalls. Case Rep. Transplant. 2018; 4863187. https://doi.org/10.1155/2018/4863187
5. Alagusundaramoorthy S.S., Vilchez V., Zanni A., Sourianarayanane A., Maynard E., Shah M., Daily M.F., Pena L.R., Gedaly R. Role of transplantation in the treatment of benign solid tumors of the liver. A review of the United Network of Organ Sharing data set. JAMA Surg. 2015; 150 (4): 337–342. https://doi.org/10.1001/jamasurg.2014.3166
6. Broering D.C., Schulte J., Fischer L., Rogiers X. Split liver transplantation. HPB (Oxford). 2004; 6 (2): 76–82. https://doi.org/10.1080/13651820310020774
7. Azoulay D., Castaing D., Adam R., Savier E., Delvart V., Karam V., Ming B.Y., Dannaoui M., Krissat J., Bismuth H. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann. Surg. 2001; 233 (4): 565–574. https://doi.org/10.1097/00000658-200104000-00013
8. Готье С.В., Латыпов Р.А., Монахов А.Р. Хирургические аспекты сплит-трансплантации печени: обзор литературы. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2019; 29 (3): 7–17. https://doi.org/10.22416/1382-4376-2019-29-3-7-17
9. Hackl C., Schmidt K.M., Süsal C., Döhler B., Zidek M., Schlitt H.J. Split liver transplantation: current developments. World J. Gastroenterol. 2018; 24 (47): 5312–5321. https://doi.org/10.3748/wjg.v24.i47.5312
10. Bismuth H., Morino M., Castaing D., Gillon M.C., Descorps Declere A., Saliba F., Samuel D. Emergency orthotopic liver transplantation in two patients using one donor liver. Br. J. Surg. 1989; 76 (7): 722–724. https://doi.org/10.1002/bjs.1800760723
11. Battula N.R., Platto M., Anbarasan R., Perera M.T., Ong E., Roll G.R., Ferraz Neto B.H., Mergental H., Isaac J., Muiesan P. Intention to split policy: a successful strategy in a combined pediatric and adult liver transplant center. Ann. Surg. 2017; 265 (5): 1009–1101. https://doi.org/10.1097/SLA.0000000000001816
12. Hashimoto K., Fung J. Abdominal organ retrieval and transplantation bench surgery. Chapter 9. In situ liver splitting. Oxford: Wiley-Blackwell, 2013. P. 101–115.
13. Voskanyan S.E., Artem'ev A.I., Sushkov A.I., Kolyshev I.Yu., Rudakov V.S., Shabalin M.V., Najdenov E.V., Mal'ceva A.P., Svetlakova D.S. Vascular reconstruction and outcomes of 220 adult-to-adult right lobe living donor liver transplantations. Almanac of Clinical Medicine. 2018; 46 (6): 598–608. https://doi.org/10.18786/2072-0505-2018-46-6-598-608 (In Russian)
14. Nakamura T., Tanaka K., Kiuchi T., Kasahara M., Oike F., Ueda M., Kaihara S., Egawa H., Ozden I., Kobayashi N., Uemoto S. Anatomical variations and surgical strategies in right lobe living donor liver transplantation: lessons from 120 cases. Transplantation. 2002; 73 (12): 1896–1903. https://doi.org/10.1097/00007890-200206270-00008
15. Ito K., Akamatsu N., Tani K., Ito D., Kaneko J., Arita J., Sakamoto Y., Hasegawa K., Kokudo N. Reconstruction of hepatic venous tributary in right liver living donor liver transplantation: the importance of the inferior right hepatic vein. Liver Transpl. 2016; 22 (4): 410–419. https://doi.org/10.1002/lt.24386
16. Mabrouk M., Mourad C.L., Kumar S., Bridget K., Mergental G.H., Isaac J., Simon R., Paolo B., Darius F., Mirza M., Thamara P., Perera R. Vasculobiliary complications following adult right lobe split liver transplantation from the perspective of reconstruction techniques. Liver Transpl. 2015; 21 (1): 63–71. https://doi.org/10.1002/lt.24015
17. Hong J.C., Yersiz H., Farmer D.G., Duffy J.P., Ghobrial R.M., Nonthasoot B., Collins T.E., Hiatt J.R., Busuttil R.W. Longterm outcomes for whole and segmental liver grafts in adult and pediatric liver transplant recipients: a 10-year comparative analysis of 2988 cases. J. Am. Coll. Surg. 2009; 208 (5): 682–689. https://doi.org/10.1016/j.jamcollsurg.2009.01.023
18. Amora-Valdes D., Leal-Leyte P., Kim P.T., Testa G. Fighting mortality in the waiting list: liver transplantation in North America, Europe, and Asia. Ann. Hepatol. 2017; 16 (4): 480–486. https://doi.org/10.5604/01.3001.0010.0271
19. Azoulay D., Castaing D., Adam R., Savier E., Delvart V., Karam V., Ming B.Y., Dannaoui M., Krissat J., Bismuth H. Split-liver transplantation for two adult recipients: feasibility and long-term outcomes. Ann. Surg. 2001; 233 (4): 565–574. https://doi.org/10.1097/00000658-200104000-00013
20. Firl D.J., Hashimoto K., O'Rourke C., Diago-Uso T., Fujiki M., Aucejo F.N., Quintini C., Kelly D.M., Miller C.M., Fung J., Eghtesad B. Role of donor hemodynamic trajectory in determining graft survival in liver transplantation from donation after circulatory death donors. Liver Transpl. 2016; 22 (11): 1469–1481. https://doi.org/10.1002/lt.24633
21. Selzner M., Kashfi A., Cattral M.S., Selzner N., Greig P.D., Lilly L., McGilvray I.D., Therapondos G., Adcock L.E., Ghanekar A., Levy G.A., Renner E.L., Grant D.R. Graft to body weight ratio less than 0.8 does not exclude adult-to-adult right-lobe living donor liver transplantation. Liver Transpl. 2009; 15 (12): 1776–1782. https://doi.org/10.1002/lt.21955
Supplementary files
Review
For citations:
Voskanyan S.E., Kolyshev I.Yu., Shabalin M.V., Artemyev A.I., Rudakov V.S., Maltseva A.P., Bashkov A.N., Syutkin V.Е., Gubarev К.К., Svetlakova D.S. Full-split liver transplantation. The first experience in Russian Federation. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021;26(1):66-75. (In Russ.) https://doi.org/10.16931/1995-5464.2021166-75