Paediatric liver transplantation with a split graft: Experience at Bicetre

This study evaluates the results of paediatric liver transplantation (PLT) with split liver grafts at Bicetre hospital. Patients and methods: Between January 1, 1988 and December 31, 1995, 205 PLT were performed in 180 children. One auxiliary PLT was excluded from the study. The graft was a whole (WLG), reduced (RLG) and split liver graft (SLG) in 76, 112 and 16 cases respectively. The SLG consisted of segments II+III in 14 cases, and II+III-IV in 2 cases. Results of PLT with SLT, RLT and WLC were retrospectively compared. Minimal follow-up was 12 months. Results: In elective PLT, actual 1 year patient (graft) survival were 93.3 % (84.4 %) with WLC (n = 64), 84.1 % (76.4 %) with RLG (n = 72), 81.8 % (81.8 %) with SLC (n = 11). In urgent LT, actual patient (graft) survival were 100 % (83.3 %) with WLC (n = 6), 58.6% (52.5 %) with RLG (n = 40), 25 % (20 %) with SLG (n = 5). Specific complications of the splitting technique were: 2 Budd-Chiari syndromes in 2 early patients, without any new case after modification of the technique of left hepatic vein to inferior vena cava anastomosis; 4 bile leaks (25 %) from the left hepatic duct to Roux-en-Y loop anastomosis. Discussion: In our experience, the results of PLT with SLC were satisfactory in the elective situation, but disappointing in urgent cases. In the current context of liver graft shortage, appropriate use of this sophisticated and demanding technique depends on the experience of the team, recipient's condition, and logistic considerations.