Split liver transplantation: Theoretical and practical aspects PDF
Preview Split liver transplantation: Theoretical and practical aspects
x. 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 Die Deutsche Bibliothek - CIP-Einheitsaufnahme A catalogue record for this publication is available from Die Deutsche Bibliothek This work is subject to copyright. AII rights are reserved, whether the whole or part of the material is concerned, specificaIIy the rights of translation, reprinting, reuse of illus trations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Steinkopff Verlag. Viola tions are liable for prosecution under the German Copyright Law. http://www.steinkopff.springer.de © Springer-Verlag Berlin Heidelberg 2002 Originally published by Steinkopff-V erlag Darmstadt in 2002 The use of general descriptive names, registered names, trademarks, etc. in this publica tion does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about the application of operative techniques and medications contained in this book. In every individual case the user must check such information by consulting the relevant literature. Production: Klemens Schwind Cover Design: Erich Kirchner, Heidelberg Typesetting: K + V Fotosatz GmbH, Beerfelden SPIN 10782735 105/7231-5 4 3 2 1 0-Printed on acid-free paper 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
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