Revisiting the forgotten “full‐right full‐left” liver division: Simplified technique and new strategical considerations for clinical implementation in Italy
Background Full‐right/full‐left liver splitting was introduced early in the 90s as part of the great wave of technical innovations that characterized that decade. One approach was to divide the liver on the right of the Cantlie's line and leave the middle hepatic vein with the left graft, with...
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Published in | Pediatric transplantation Vol. 28; no. 1; pp. e14655 - n/a |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Denmark
Wiley Subscription Services, Inc
01.02.2024
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Subjects | |
Online Access | Get full text |
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Summary: | Background
Full‐right/full‐left liver splitting was introduced early in the 90s as part of the great wave of technical innovations that characterized that decade. One approach was to divide the liver on the right of the Cantlie's line and leave the middle hepatic vein with the left graft, with both grafts allocated to adults. Both grafts had some functional disadvantages and exposed the adult recipients to some early hepatic dysfunction, and the results were not great. An alternative approach consisted of an ex situ division of the liver, exactly along Cantlie's line, thus sharing the middle hepatic vein between the two grafts. None of these two techniques were really adopted, and there has been nearly no transplantation of this type in the last decade worldwide.
Method and results
The authors propose a variation of the latter technique that was used recently with success: The division of the liver is made simpler; the two grafts are prepared ex situ and need a simple vascular reconstruction (one venous patch on each graft); and the grafts can be implanted using very standard techniques.
Conclusion
Because candidates for liver transplantation weighing 25–60 kg (old children, teenagers, and some small adults) are often at some disadvantage in getting size‐matched livers (this range of weight is less represented in the donor population), implementing the latter technique would help provide adequate grafts for them. In Italy, where many livers offered for splitting are not used, there would be ample room for implementing this option within the actual donor pool and allocation system. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1397-3142 1399-3046 |
DOI: | 10.1111/petr.14655 |