It is unknown what the potential increases in the number of liver grafts could be if the technique of splitting optimal organs was systematically used.
A study from researchers at the Transplantation Unit of the University Hospitals, Geneva, Switzerland, has therefore examined the proportion of donors that could be considered for in situ split-liver harvesting according to strict criteria on which a consensus could easily be reached.
The research team examined the records of 407 consecutive donors during a 4-year period.
The study population was reduced to 338 donors by excluding from the study all non-heart-beating donors and donors with missing data.
Liver splitting was considered to be feasible if several strict criteria were met.
These included age ≤14 and ≤50 years, weight ≥45 kg, body mass index ≤26 kg/m2, and an intensive care stay ≤3 days.
In additional, suitable donors had to have mean arterial pressure ≥60 mm Hg, Na ≤160 mmol/l, serum glutamic pyruvic transaminase ≤60 U/l and gamma-glutamyl transpeptidase ≤50 U/l.
|15% of donors were suitable for split-liver harvesting |
| Transplantation |
There must also be no steatosis at ultrasonography.
Organs from donors ≥70 kg were considered suitable for a split, producing organs for 2 adults.
Following examination of the study group, a total of 52 donors (15%) were identified as fulfilling all the conditions for a split-liver procedure.
Of these 52 patients, 29 (8.6%) were donors for 2 adults.
If donors with only one missing criterion were also included as suitable candidates for the split-liver procedure then the number of donors increased to 145 (43%), of which 77 (23%) could provide liver grafts for 2 adults.
"Even of the technique is restricted to optimal donors, splitting could appreciably increase the number of liver grafts", commented Dr Christian Toso, a member of the group that carried out the study.
"A wider use of the technique could reduce the patient's time on the waiting list and the need for living-donor procedures, and should be encouraged", he concluded.