Adult left liver transplantation from split livers and living donors: a 14‐year single‐center experience

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>In an era of organ scarcity, the use of left liver grafts for adult recipients could increase the access to liver transplantation (<jats:styled-content style="fixed-case">LT</jats:styled-content>). The aim of this study was to evaluate the results in a single‐center series of adult left <jats:styled-content style="fixed-case">LT</jats:styled-content> over a 14‐yr period.</jats:p></jats:sec><jats:sec><jats:title>Patients and methods</jats:title><jats:p>Between March 1996 and March 2010, 30 adult patients underwent <jats:styled-content style="fixed-case">LT</jats:styled-content> with a left liver obtained from 16 split cadaveric livers and 14 living donors (<jats:styled-content style="fixed-case">LD</jats:styled-content>). Portal vein inflow modulation was performed in selected cases.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 19 (63.3%) grafts had early dysfunction leading to graft failure in six cases (20%). One third of the grafts developed small‐for‐size syndrome (<jats:styled-content style="fixed-case">SFSS</jats:styled-content>). One‐yr patient and graft survival was 80% and 76.7%, respectively. Regarding two successive periods, one‐yr patient and graft survival dramatically increased from 62.5% to 100% (p = 0.01) and 56.2% to 100% (p = 0.002), respectively. Multivariate analysis disclosed that completion of a portosystemic shunt and the occurrence of post‐operative ascites were significantly associated with graft failure.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results support that improved surgical techniques and careful patient selection can lead to a safe use of left livers for transplantation in adult recipients. Inflow modulation could be performed in very selected cases.</jats:p></jats:sec>