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Split liver transplants as successful as whole organ transplants, study finds

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Of the nearly 16,000 people on waiting lists for a liver transplant, approximately 10 percent die before they are chosen for surgery. One solution for this organ shortage is a split liver transplant, where the donor liver is divided and transplanted into two patients.

And now, new research from the Cleveland Clinic has found that this split-liver technique has a five-year survival rate comparable to that of whole liver surgery.

“The main purpose of the procedure is to… increase the number of transplants,” Dr. Koji Hashimoto, a transplant surgeon at the Cleveland Clinic, told FoxNews.com. “The important thing is the liver is the only organ in the body that can regenerate— if you split the liver into two pieces, these pieces can regenerate and the size of the liver goes back to normal. This is a very unique organ.”

Some of the causes of liver failure include alcoholism, hepatitis B, hepatitis C and nonalcoholic steatohepatitis (NASH) – a common disease that causes fat in the liver.

From April 2004 to June 2012, researchers performed transplant surgery on a group of 25 split-liver recipients and a control group of 121 whole liver recipients. Split-liver recipients had an 80 percent five-year survival rate, while whole liver recipients had an 81.5 percent survival rate for the same period.  

The complications for a split liver recipient are about the same as for a whole liver recipient and can include the development of small blood clots in the liver as well as primary nonfunction, or when the liver does not work after transplant.

Because of the liver’s anatomy, it cannot be split evenly for transplantation. With this procedure the organ is divided in two— 35 to 40 percent is the left lobe and 65 to 70 percent is the right lobe. One benefit of organ division is that it allows smaller patients who weigh between 100 and 160 pounds to receive needed surgery, since the split liver halves are smaller than the whole organ.

“Most of the time, these small recipients were bypassed, so let’s say we have a very small recipient on the top of the list and have a big donor. I think in this country, most centers bypass the small recipient and transplant the big liver to somebody lower on the waiting list,” Hashimoto said.

The split-liver procedure, which was first utilized by the Cleveland Clinic in 2004, is not widely done because of the technical challenge, Hashimoto noted. The process of splitting the liver is tricky, and surgeons must also divide the blood vessels, sometimes using a microscope to do so. All liver donations come from deceased donors and the splitting occurs in the donor body.

The most important factor for a successful split liver surgery is making good-sized matches between donors and recipients, which can be difficult because of the large waiting list.  Additionally, the process of identifying a donor and making the right matches has to happen within 24 hours.

“But you can increase the number of transplants, can save more people— can save two patients from one donor, which is a great concept I think,” he said. “If you choose the right donor and the right recipient, it works.”