Potential impact of in situ liver splitting on the number of available grafts

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Abstract
The potential increase in the number of liver grafts gained from systematically using the technique of splitting optimal organs is still unknown. This study investigates the proportion of donors that should be considered for in situ split-liver harvesting according to strict criteria on which a consensus could be reached easily. The records of 407 consecutive donors during a 4-year period in Switzerland were analyzed. Non-heart-beating donors and donors with missing data were excluded, leaving 338 donors as the study population. Liver splitting was considered feasible when the following criteria were met: age≥14 and ≤50 years; weight≥45 kg; body mass index≤26 kg/m2; intensive care stay≤3 days; mean arterial pressure≥60 mm Hg; Na≤160 mmol/L; serum glutamic pyruvic transaminase≤60 U/L; γ-glutamyl transpeptidase≤50 U/L; no steatosis at ultrasonography. Organs from donors≥70 kg were considered suitable for a split, producing organs for two adults. Fifty-two (15%) donors fulfilled all the conditions for a split-liver procedure, of whom 29 (8.6%) were donors for 2 adults. The number of donors suitable for splitting increased to 145 (43%) if donors with only one missing criterion were included (77 [23%] for 2 adults). Even if the technique is restricted to optimal donors, splitting could appreciably increase the number of liver grafts. 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.