Table Of Contentx.
ROGiERS l1li H. BISMUTH III R.W. BUSUTTIL l1li D.C. BROERING l1li D. AZOULAy!III (Eds.)
Split liver transplantation
Theoretical and practical aspects
x.
Split liver
ROGIERS
H. BISMUTH transplantation
W.
R. BUSUTTIL
D. C. Theoretical
BROERING
D. and practical aspects
AZOULAY
(Eds.)
With 55 figures
in 76 separate illustrations
and 20 tab les
, Springer
XAVIER ROGIERS, MD DIETER C. BROERING, MD
Universitatsklinikum Universitatsklinikum
Hamburg-Eppendorf Hamburg-Eppendorf
Abt. fur Hepatobiliare Chirurgie Abt. fur Hepatobiliare Chirurgie
MartinistraBe 52 MartinistraBe 52
20246 Hamburg, Germany 20246 Hamburg, Germany
HENRI BISMUTH, MD DANIEL AZOULAY, MD
Hopital Paul Brousse Hopital Paul Brousse
12, av. Paul Vaillant Couturier Departement of Hepatobiliary
94804 Villejuif Cedex, France Surgery
14, av. Paul Vaillant Couturier
RONALD W. BUSUTTIL, MD 94850 Villejuif Cedex, France
University of California
Los Angeles
Transplant Center
Department of Surgery
10833 LeConte Ave.
Los Angeles, CA 90024, USA
ISBN 978-3-7985-1256-6 ISBN 978-3-642-57523-5 (eBook)
DOI 10.1007/978-3-642-57523-5
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Preface
The last decade has seen an explosion in the surgical efforts to
overcome the shortage of liver grafts for transplantation. The
end of the 1990s saw the development of the concepts of reduced,
split and living donor transplantation by the transplant pioneers
and their first applications in practice. During the 1990s many
centers throughout the world invested their experience to further
develop this into safe and teachable standardized procedures with
excellent results. The result of this development is not only that
split liver transplantation between adults and children became
a validated surgical technique, but also the real possibility of
achieving 0% mortality for children on the waiting list today.
However, like many new surgical techniques, its success does not
only depend on adequate patient selection (in this case selection of
the donor and the recipients!), but also on the avoidance of mis
takes that were already experienced by previous surgeons. It is this
principle, combined with the need of spreading split liver trans
plantation knowledge, that led to the organization of the first prac
tical split liver transplantation course in Hamburg in March 2000.
Writing about the surgeon scientist, Joseph E. Murray de
scribed one of the differences between the scientist and sur
geon: The scientist can wait for all the data to become avail
«
able whereas the surgeon must make a decision based on avail
able data." This book aims to provide the surgeon, who wants
to start split liver transplantation with the data available today.
Experienced transplant surgeons, who taught in the course,
present different aspects of split liver transplantation from sur
gical anatomy to technical performance, from donor and recipi
ent selection to the organizational aspect, from historical as
pects to future visions!
We hope that this book may contribute to the propagation of
the split liver technique and may encourage research to develop
split liver transplantation for two adult patients.
Hamburg, June 2002 XAVIER ROGIERS
List of contents
I
1 History, status quo aM logistics
1.1 History of split liver transplantation 3
J.B.OTTE
1.2 Split liver transplantation:
what has been done and where is the need . . . . . . .. 10
A. KOENIGSRAINER, R. LADuRNER, and R. MARGREITER
1.3 Logistic aspects and procedures
in split liver transplantation ................... 17
T. KARBE, R. KUETEMEYER, D. C. BROERING,
and X. ROGIERS
1.4 Allocation policies, logistics, and resource demands
of living-related donor and split liver grafts: -
the American experience ...................... 25
J.
REYES
21
Anatomy
2.1 Anatomy of the liver ......................... 35
G. KAZEMIER and J. F. LANGE
2.2 Consequences of anatomy for the split liver surgeon 46
D. C. BROERING, J. SCHULTE AM ESCH, and X. ROGIERS
2.3 Which liver is splitable? . . . . . . . . . . . . . . . . . . . . . .. 63
H. J. SCHLITT
VIII List of contents
31
Techniques for splitting the liver
3.1 The Paris technique . . . . . . . . . . . . . . . . . . . . . . . . .. 69
D. AZOULAY and D. CASTAING
3.2 Technique for ex situ cadaveric liver graft division 75
J. DE VILLE DE GOYET
3.3 Technique of left-lateral in situ splitting .......... 88
D. C. BROER lNG, C. HILLERT, and X. ROGIERS
3.4 In situ splitting «Full right - Full left"
for two adult recipients ....................... 96
J. BELGHITI, G. M. ETTORE, D. SOMMACALE,
A. SAUVANET, and O. FARGES
I
4 The recipient
4.1 How much liver does the patient need? . . . . . . . . . .. 105
T. KIUCHI and K. TANAKA
4.2 Transplantation of the right liver graft -
technical aspects ............................ 115
M. GUNDLACH, S. Topp, D. C. BROER lNG,
and X. ROG IERS
4.3 Technique of implantation of the left graft ........ 120
B. GRIDELLI
5 1 Results and outlook
5.1 Results of ex situ split liver transplantation ....... 129
S. Topp, D. C. BROERING, and X. ROGIERS
5.2 Results of in situ splitting ..................... 136
R. M. GHOBRIAL, H. YERSIZ, F. AMERSI,
and R. W. BUSUTTIL
5.3 The paradigm of split liver transplantation:
a word of caution. . . . . . . . . . . . . . . . . . . . . . . . . . .. 147
M. J. H. SLOOFF and E. SIEDERS
List of contents IX
5.4 Split liver transplant for two adults:
initial experience at Paul Brousse Hospital ........ 153
D. AZOULAY, G. MARIN-HARGREAVES, and H. BISMUTH
5.5 Split liver transplantation outlook to the future 157
H. BISMUTH
List of contributors
FARIN AMERSI, MD RONALD W. BUSUTTIL, MD
University of California University of California
Los Angeles Los Angeles
Transplant Center Transplant Center
Department of Surgery Department of Surgery
10833 LeConte Ave. 10833 LeConte Ave.
Los Angeles, CA 90024, USA Los Angeles, CA 90024, USA
DANIEL AZOULAY, MD DENIS CASTAING, MD
Hopital Paul Brousse Hopital Paul Brousse
Departement of Hepatobiliary Departement of Hepatobiliary
Surgery Surgery
14, avo Paul Vaillant Couturier 14, avo Paul Vaillant Couturier
94850 Villejuif Cedex, France 94800 Villejuif Cedex, France
JAQUES BELGHITI, MD JEAN DE VILLE DE GOYET, MD
Hopital Beaujon Birmingham Children's Hospital
100, bd. du General-Leclerc Steelhouse Lane
92118 Clichy Cedex, France Birmingham B46NH
United Kingdom
HENRI BISMUTH, MD
Hopital Paul Brousse GUISEPPE M. ETTORE, MD
12, avo Paul Vaillant Couturier Hopital Beaujon
94804 Villejuif Cedex, France 100, bd. du General-Leclerc
92118 Clichy Cedex, France
DIETER C. BROERING, MD
Universitatsklinikum OLIVIER FARGES, MD
Hamburg-Eppendorf Hopital Beaujon
Abteilung fUr Hepatobiliare 100, bd. du General-Leclerc
Chirurgie 92118 Clichy Cedex, France
MartinistraBe 52
20246 Hamburg, Germany
XII List of contributors
RASHID M. GHOBRIAL, MD TETSUJA KIUCHI, MD
University of California Kyoto University Hospital
Los Angeles Department of Transplant
Transplant Center Surgery
Department of Surgery 54, Kawara-Kyoto, Shogoin
10833 LeConte Ave. Sakyo-Ku Kyoto 606-8507, Japan
Los Angeles, CA 90024, USA
ALFRED KOENIGSRAINE~ MD
BRUNO GRIDELLI, MD Universitat Innsbruck
Ospedali Riuniti Klinische Abteilung fur
Department of Pediatric Liver Transplantations-Chirurgie
Transplantation AnichstraBe 35
Largo Barozzi 1 6020 Innsbruck, Austria
24100 Bergamo, Italy
ROBERT KUETEMEIER
Universitatsklinikum
MATTHIAS GUNDLACH, MD
Klinik fur Allgemein-, Hamburg-Eppendorf
Visceral- und Thoraxchirurgie Abteilung fur Hepatobiliare
Klinikum Duisburg Chirurgie
Wedaukliniken MartinistraBe 52
Zu den Rethwesen 9 20246 Hamburg, Germany
47055 Duisburg, Germany
RUTH LADURNER, MD
Universitatsklinik fur Chirurgie
CHRISTIAN HILLERT, MD
Universitatsklinikum AnichstraBe 35
Hamburg-Eppendorf 6020 Innsbruck, Austria
Abteilung fur Hepatobiliare
Chirurgie JOHAN F. LANGE, MD
MartinistraBe 52 Hospital Erasmus
20246 Hamburg, Germany Medical Clinic
Dr. Molewaterplain 40
3015 GD Rotterdam
TOM KARBE
Universitatsklinikum The Netherlands
Hamburg-Eppendorf
Abteilung fur Hepatobiliare REIMUND MARGREITER, MD
Universitatsklinik fur Chirurgie
Chirurgie
AnichstraBe 35
MartinistraBe 52
6020 Innsbruck, Austria
20246 Hamburg, Germany
GUILLERMO
GEERT KAZEMIER, MD
Hospital Erasmus MARIN-HARGREAVES, MD
Hopital Paul Brousse
Medical Clinic
IS, avo Paul Vaillant Couturier
Dr. Molewaterplain 40
94850 Villejuif Cedex, France
3015 GD Rotterdam
The Netherlands
JEAN-BERNARD OTTE, MD
Universite Catholique de Louvain
Cliniques Universitaires Saint-Luc
Avenue Hippocrate
10 UCL 1011401
1200 Brussels, Belgium
List of contributors XIII
JORGE REYES, MD MARTIN J. H. SLOOFF, MD
University of Pittsburgh Hepatobiliary Surgery
Department Transplant Surgery Academisch Ziekenhuis
4th FI. Falk Clinic Groningen
3601 Fifth Ave P.O. Box 30001
Pittsburgh, PA L5238, USA 9700 RH Groningen
The Netherlands
XAVIER ROGIERS, MD
Universitatsklinikum DANIEL SOMMACALE, MD
Hamburg-Eppendorf Hopital Beaujon
Abteilung fur Hepatobiliare 100, bd. du General-Leclerc
Chirurgie 92118 Clichy Cedex, France
MartinistraBe 52
20246 Hamburg, Germany KorCHI TANAKA, MD
Kyoto University Hospital
ALAIN SAUVANET, MD Department of Transplantation
Hopital Beaujon and Immunology
100, bd. du General-Leclerc 54, Kawara-Kyoto, Shogoin
92118 Clichy Cedex, France Sakyo-Ku Kyoto 606-8507, Japan
HANS J. SCHLITT, MD STEFAN Topp, MD
Medizinische Hochschule Universitatsklinikum
Hannover Hamburg-Eppendorf
Klinik fur Viszeral- und Abteilung fur Hepatobiliare
Transplant -Chirurgie Chirurgie
Carl NeubergstraBe 1 MartinistraBe 52
30623 Hannover, Germany 20246 Hamburg, Germany
JAN SCHULTE AM ESCH, MD HASSAN YERSIZ, MD
Universitatsklinikum University of California
Hamburg-Eppendorf Los Angeles
Abteilung fUr Hepatobiliare Transplant Center
Chirurgie Department of Surgery
MartinistraBe 52 10833 LeConte Ave.
20246 Hamburg, Germany Los Angeles, CA 90024, USA
EGBERT SIEDERS, MD
Hepatobiliary Surgery
Academisch Ziekenhuis
Groningen
P.O. Box 30001
9700 RH Groningen
The Netherlands
