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Objective:
Describe the use of segmental allografts as an important strategy using innovative surgical techniques in liver transplantation to increase organ availability.
Design:
Retrospective study of liver transplants performed from August 2007 to February 2012.
Setting:
Academic Tertiary Care Center
Patients and Interventions:
199 consecutive Liver Transplants patients were reviewed, 59(29%) patients received segmental grafts. 33 males, mean age of 22yo (4m-69y). Received either living donor liver transplant (LDLTx) or a segmental transplant from a deceased donor (Split or Reduced size). Main Outcome Measures:
Graft type, vascular complications, patient&graft survival.
Results:
Out of 59 segmental transplants, 38 underwent LDLTx. 11(29%) grafts were Right Lobes, 16(42%) Left lobes and 11(29%)Left Lateral segments (LLS).
21 patients were transplanted with deceased donor segmental grafts of these 10(48%) were Right Trisegmentectomies, 9(42%) LLS, 1(5%) R-Lobe and 1(5%) L-lobe.
There were no HAT (0%), no PVT(0%)
One (1.6%) patient on the group developed hepatic artery stenosis (HAS) and was treated with balloon angioplasty by interventional radiology.
Arterial anastomosis were done using interrupted 8-0 monofilament sutures. Most patients received prophylactic dose of low molecular weight heparin for a week and aspirin indefinitely.
In split liver transplantation our preferred technique is in-situ splitting.
Graft and Patient survival was 98% and 100% respectively.
Conclusions:
Use of segmental allografts is essential in order to offer timely transplantation and decreasing waiting list mortality. LDLTx and Segmental grafts from deceased donors are complementary. The outcomes presented are a combination of technical expertise, routine use of anticoagulation and strict patient and donor selection.