Split Liver Transplant From Deceased Marginal Donor: A Case Report |
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| Institution: | 1. Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan;2. Department of Cardiology and Nephrology, Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan;3. Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan;4. Department of Advanced Transplant and Regenerative Medicine, Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan;1. Nephrology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal;2. Nephrology Department, Hospital Beatriz Ângelo, Loures, Portugal;3. Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal;4. Hematology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.;1. Bioethics Unit, Italian National Institute of Health, Rome, Italy;2. National Transplant Centre, Italian National Institute of Health, Rome, Italy;3. Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy;4. Legal Medicine and Transplant Coordination, Policlinico San Martino Hospital, Genoa, Italy;5. Department of Organ Failure and Transplantation, ASST Giovanni XXIII, Bergamo, Italy;6. Department of Cardio-Thoracic-Vascular Sciences and Public Health, Unit of Thoracic Surgery and Lung Transplantation, Hospital University of Padua, Padua, Italy;7. Thoracic Surgery and Lung Transplantation Unit, University of Milan, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy;1. Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA;2. Advanced Heart Failure Division, Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, IN, USA;3. Clinical Medicine Division, Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, IN, USA;4. Clinical Surgery, Indiana University School Of Medicine, Indianapolis, IN, USA |
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| Abstract: | The relative paucity of deceased donor organs and the progressive increase in patients with cirrhosis have led transplant centers to consider organs from marginal donors (elderly donors, prolonged stay in the intensive care unit (ICU), liver steatosis—steatotic grafts, severe hypernatremia, and use of inotropes). Recently, the use of those marginal grafts has increased, but splitting liver is still debatable.Herein, we present a 28-year-old deceased donor who had a history of traumatic brain injury. The patient stayed in ICU for 3 days with high sodium level (188 mEq/L) and was hemodynamically supported with single inotrope. At the time of procurement, core biopsies were taken from the right lobe and left lateral segment of the liver, with results demonstrating 5% necrosis. A decision was made for split liver transplant as left lateral sector and extended right lobe.Liver graft was divided into a left lateral segment to be transplanted to a 4-year-old child with secondary biliary cirrhosis due to previous liver transplant and a right extended liver lobe for an adult patient with hepatocellular carcinoma waiting 10 months on the waiting list. Both liver transplants were performed uneventfully. Patients were discharged on the 11th and 56th days after transplant. The liver function tests remained normal during the follow up period of 2 years.A marginal graft with more than one risk factor should not be discarded liberally. Splitting such grafts could be considered in a highly selective recipients. |
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