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Surgical experience in splitting donor liver into left lateral and right extended lobes

World Journal of Gastroenterology 2005年第27期11卷 4220-4224页

作者： Ji-Qi Yan Thomas Becker Michael Neipp Cheng-Hong Peng Rainer Lueck Frank Lehner Hong-Wei Li Juergen Klempnauer Department of Surgery Ruijin Hospital Affiliated to Shanghai Second Medical University Shanghai 200025 China Department of Abdominal and Transplant Surgery Medical School of Hannover Carl-NeubergStr. 1 Hannover 30625 Germany

AIM： To outline the surgical experience with donor liver splitting in split liver ***： From March 1 to September 1 in 2004, 10 donor livers were split ex situ into a left lateral lobe （segments Ⅱ and Ⅲ） and a right extended lobe （segments Ⅰ, Ⅳ-Ⅷ） in Medical School of Hannover, and thereafter split liver transplantation was performed successfully in 29 cases. The average age, weight and ICU slaying period of the donors were 32.7 years （25-52 years）, 64.5 kg（45-75 kg） and 2.4 d （2-8 d） ***： The average weight of the whole graft and the left lateral lobe was 2 322.6 g （956-2 665 g） and 282.8 g （298-373 g） respectively, and the average ratio of left lateral lobe to the whole graft was 0.225 （0.278-0.274）.The average graft to recipient weight ratio （GRWR） of the left lateral lobe and the right extended lobe reached 2.44% （2.22-5.42%） and 2.73% （2.32-2.30%） *** average it took approximately 205 min （85-235 rain）to split the donor liver. Five donor organs showed anatomic variation including the left hepatic vein variation in two cases, the left hepatic artery variation in two cases and the bile duct variation in one ***： Split liver transplantation has become a mature surgical technique to expand the donor pool with promising results. In the process of graft splitting, close attention needs to be paid to potential anatomic variations,especially to variations of the left hepatic vein, the left hepatic artery, and the bile duct.

关键词： Split donor liver Anatomic variation

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The influence of brain death on donor liver and the potential mechanisms of protective intervention

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Frontiers of Medicine 2011年第1期5卷 8-14页

作者： Shui-Jun ZHANG Tao WANG The First Affiliated Hospital of Zhengzhou University Zhengzhou 450052China

Brain-dead donors have become one of the main sources of organs for transplantation in Western *** quality of donor organs is closely related to the outcome of the *** studies have confirmed the inferior graft survival of livers from brain-dead donors compared with those from living *** conducted in the past 10 years have shown that brain death is associated with effects on the decreased donor organ ***,whether the decrease in the viability of donor organs is caused by brain death or by the events before and after brain death remains *** purpose of this review is to introduce the advances and controversies regarding the influence of brain death on the viability of donor livers and to summarize the mechanisms of the different protective interventions for donor livers.

关键词： brain death donor liver

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Split liver transplantation: a reliable approach to expand donor pool

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Hepatobiliary & Pancreatic Diseases International 2005年第3期4卷 339-344页

作者： Ji-Qi Yan, Thomas Becker, Cheng-Hong Peng, Hong-Wei Li and Juergen Klempnauer Department of Surgery, Ruijin Hospital Affiliated to Shanghai Second Medical University, Shanghai 200025, China ( Yan JQ, Peng CH and Li HW) Department of Abdominal and Transplant Surgery, Medical School of Hannover, Carl-Neuberg-Str. 1 , 30625 Hannover, Germany Department of Surgery Ruijin Hospital Affiliated to Shanghai Second Medical University Shanghai 200025 China. jiqiyan@***

Orthotopic liver transplantation as a successful treatment of end-stage liver disease is hampered by a persistent lack of cadaveric organs. Split liver transplantation, which was first successfully performed by Medical School of Hannover in 1988, has become a mature surgical technique to expand the donor pool. Between 1993 and 1999, split liver transplantation activities have increased in Europe from 1. 2% to 10. 4% in all performed liver transplantations. Current data have strongly supported that the survival rate of patients after split liver transplantation is not significantly different from that of patients after whole-size orthotopic liver transplantation. The most important step of donor graft selection is surgeon' s observation judged by the experience of individual transplant center. The paper aims to provide the guideline of donor selection, hepatic graft splitting, and recipient management as well. DATA SOURCES: Medical School of Hannover has accumulated plentiful experience of split liver transplantation for more than 10 cases ever since 1998. Besides that, we also reviewed a variety of literatures from other famous European and American centers specialized in this field for many years. RESULTS:According to our experience combined with the view points of others, the donor should meet the following criteria as well: (1) age less than 50 years; (2) hemodynamics stable; (3) ICU less than 5 days; (4) Na less than 170 mmol/L or better if less than 150 mmol/L. In 1996 and 1997, the Hamburg group and the UCLA group separately introduced a breakthrough technique performing split liver transplantation in situ. Evidently, the in situ technique has been limited by prolonged time of donor organ procurement , coordination with other organ procurement teams, and even extra burden on donor hospital. Some groups, therefore, have restored the ex situ or bench splitting technique , and fortunately the transplant outcomes of the ex situ technique are equivalent to those of

关键词： donor liver split transplantation

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