Split liver transplantation with extended right grafts under patient-oriented allocation policy: single center matched-pair outcome analysis

Background: Split liver transplantation (SLT) is an established technique developed to optimize the number of available grafts. Few data are available on SLT with extended right liver grafts (eRLG) in the context of patient-oriented allocation policy. Methods: Between July 1, 2001 and December 31, 2005, 12 whole liver graft (WLG) recipients were matched with 12 eRLG recipients according to their clinical status, indication and year of liver transplantation. Results: There were no differences according to recipient Model for End-stage Liver Disease score, total serum bilirubin, creatinine levels and international normalized ratio in both groups. Fifty percent of donors in eRLG group presented 2 or more extended criteria. Liver transplantation was performed in UNOS status 1/2A in 58% of cases in both groups. Vascular and biliary complications were observed in three patients in the eRLG group. The median follow-up was 25.3 months (range 0.4-63). Early mortality (<= 3 m) was 16.7% in WLG vs. 0% in eRLG, respectively (p = n.s.). Five-yr patient and graft survival rates were 84% and 77%, and 75% and 68%, respectively, for WLG and eRLG. Conclusion: Split liver transplantation with eRLG according to the patient-oriented allocation policy can be performed under emergency or urgent care circumstances with acceptable morbidity and adequate long-term survival

Improved results for adult split liver transplantation with extended right lobe grafts: could we enhance its application?

Objective. Split liver transplantation (SLT) allows grafting of 2 recipients with I allograft. Results of adult SLT have improved since its first introduction. Children benefit most from SLT, while among some adult liver transplanters there are concerns about splitting a liver, turning a good quality graft into a marginal one. We performed a single center retrospective review to address this issue. Patients and Methods. Between June 2001 and August 2008, we performed 22 extended right liver graft (eRLG) transplantations in 21 adult patients. Results. Eleven donors (50%) did not meet the Eurotransplant criteria for optimal donors. Forty-one percent of eRLG donors showed hemodynamic instability at the time of harvest. Eighteen (82%) splitting procedures were performed ex situ. The main indications for transplantation were alcoholic liver cirrhosis (32%), hepatitis C-related cirrhosis (18%), and acute liver failure (18%). Mean recipient age was 54 years (range, 17-69 years); median Model for End-Stage Liver Disease (MELD) score was 15 (range, 7-40). Patients were followed for a median of 16 months (range, 4-92 months) following transplantation. We observed 5 (23%) vascular and 3 (14%) biliary complications. Overall patient survival was 84% at 3 years; overall graft survival was 79%. For the 11 patients who had undergone transplantation after 2007, we observed a 100% patient and graft survival. Conclusion. After an initial learning curve and provided careful selection, exceptions to classical donor criteria for splitting can be accepted with successful outcomes comparable to those after whole liver transplantation

Preanalytical variables influencing the interpretation and reporting of biological tests on blood samples of living and deceased donors for human body materials

With the present paper, the Working Group on Cells, Tissues and Organs and other experts of the Superior Health Council of Belgium aimed to provide stakeholders in material of human origin with advice on critical aspects of serological and nucleic acid test (NAT) testing, to improve virological safety of cell- and tissue and organ donation. The current paper focusses on a number of preanalytical variables which can be critical for any medical biology examination: (1) sampling related variables (type of samples, collection of the samples, volume of the sample, choice of specific tubes, identification of tubes), (2) variables related to transport, storage and processing of blood samples (transport, centrifugation and haemolysis, storage before and after centrifugation, use of serum versus plasma), (3) variables related to dilution (haemodilution, pooling of samples), and (4) test dependent variables (available tests and validation). Depending on the type of donor (deceased donor (heart-beating or non-heart beating) versus living donor (allogeneic, related, autologous), and the type of donated human material (cells, tissue or organs) additional factors can play a role: pre- and post-mortem sampling, conditions of sampling (e.g. morgue), haemodilution, possibility of retesting.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Preanalytical variables influencing the interpretation and reporting of biological tests on blood samples of living and deceased donors for human body materials

With the present paper, the Working Group on Cells, Tissues and Organs and other experts of the Superior Health Council of Belgium aimed to provide stakeholders in material of human origin with advice on critical aspects of serological and nucleic acid test (NAT) testing, to improve virological safety of cell- and tissue and organ donation. The current paper focusses on a number of preanalytical variables which can be critical for any medical biology examination: (1) sampling related variables (type of samples, collection of the samples, volume of the sample, choice of specific tubes, identification of tubes), (2) variables related to transport, storage and processing of blood samples (transport, centrifugation and haemolysis, storage before and after centrifugation, use of serum versus plasma), (3) variables related to dilution (haemodilution, pooling of samples), and (4) test dependent variables (available tests and validation). Depending on the type of donor (deceased donor (heart-beating or non-heart beating) versus living donor (allogeneic, related, autologous), and the type of donated human material (cells, tissue or organs) additional factors can play a role: pre- and post-mortem sampling, conditions of sampling (e.g. morgue), haemodilution, possibility of retesting