Split liver transplantation - Theoretical and practical aspects

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, com bined 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.

Inhaltsverzeichnis:

1.1 History of split liver transplantation.- 1.2 Split liver transplantation: what has been done and where is the need.- 1.3 Logistic aspects and procedures in split liver transplantation.- 1.4 Allocation policies, logistics, and resource demands of living-related donor and split liver grafts: - the American experience.- 2.1 Anatomy of the liver.- 2.2 Consequences of anatomy for the split liver surgeon.- 2.3 Which liver is splitable?.- 3.1 The Paris technique.- 3.2 Technique for ex situ cadaveric liver graft division.- 3.3 Technique of left-lateral in situ splitting.- 3.4 In situ splitting "Full right - Full left" for two adult recipients.- 4.1 How much liver does the patient need?.- 4.2 Transplantation of the right liver graft - technical aspects.- 4.3 Technique of implantation of the left graft.- 5.1 Results of ex situ split liver transplantation.- 5.2 Results of in situ splitting.- 5.3 The paradigm of split liver transplantation: a word of caution.- 5.4 Split liver transplant f or two adults: initial experience at Paul Brousse Hospital.- 5.5 Split liver transplantation outlook to the future.