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| 1 | Split liver transplantation: a reliable approach to expand donor pool显示文摘Orthotopic liver transplantation as a successful treatment of end-stage liver disease is hampered by a persistent lack of cadaveric organs. Split liver transplantation, which was first successfully performed by Medical School of Hannover in 1988, has become a mature surgical technique to expand the donor pool. Between 1993 and 1999, split liver transplantation activities have increased in Europe from 1. 2% to 10. 4% in all performed liver transplantations. Current data have strongly supported that the survival rate of patients after split liver transplantation is not significantly different from that of patients after whole-size orthotopic liver transplantation. The most important step of donor graft selection is surgeon’ s observation judged by the experience of individual transplant center. The paper aims to provide the guideline of donor selection, hepatic graft splitting, and recipient management as well. DATA SOURCES: Medical School of Hannover has accumulated plentiful experience of split liver transplantation for more than 10 cases ever since 1998. Besides that, we also reviewed a variety of literatures from other famous European and American centers specialized in this field for many years. RESULTS:According to our experience combined with the view points of others, the donor should meet the following criteria as well: (1) age less than 50 years; (2) hemodynamics stable; (3) ICU less than 5 days; (4) Na less than 170 mmol/L or better if less than 150 mmol/L. In 1996 and 1997, the Hamburg group and the UCLA group separately introduced a breakthrough technique performing split liver transplantation in situ. Evidently, the in situ technique has been limited by prolonged time of donor organ procurement , coordination with other organ procurement teams, and even extra burden on donor hospital. Some groups, therefore, have restored the ex situ or bench splitting technique , and fortunately the transplant outcomes of the ex situ technique are equivalent to those of the in situ one. Recently some new techniques have been introduced to split the liver for two adult patients, including the split-cava technique. CONCLUSIONS:It is clear that the most important factor for determining the prognosis of the patient is the time of receiving liver transplantation, not the type of liver transplantation. We still need to pay close attention to the graft to recipient weight ratio (GRWR) and the UNOS classification or MELD score before the patient is subjected to split liver transplantation. | Ji-Qi Yan, Thomas Becker, Cheng-Hong Peng, Hong-Wei Li and Juergen Klempnauer Department of Surgery, Ruijin Hospital Affiliated to Shanghai Second Medical University, Shanghai 200025, China ( Yan JQ, Peng CH and Li HW) Department of Abdominal and Transplant Surgery, Medical School of Hannover, Carl-Neuberg-Str. 1 , 30625 Hannover, Germany | 2005 | Hepatobiliary & Pancreatic Diseases International2005，4，3： | 3 |
| 2 | Early Membrane Oxygenation for After Lung TransplantationImproves Outcome显示文摘 | Christopher HW Joshua DL Institution of Extracorporeal Primary Graft Dysfunction Thomas GS | 2007 | J of Heart and Lung Transplantation2007，26，4： | 1 |
| 3 | The search for autism disease genes显示文摘 | Thomas HW Linda MB Christopher WB | 2004 | Met Retard Dev Disabil Res Rev2004，10，： | 1 |
| 4 | Fluorometric assessments ofmitochondrial function and viability in cryopreserved bovine spermatozoa显示文摘 | Garner DL Thomas CA Joerg HW | 1997 | BiolReprod1997，57，6： | 1 |
| 5 | Fluorometric assessments of mitochondrial function and viability in cryopreserved bovine spermatozoa 显示文摘 | Garner DL Thomas CA Joerg HW | 1997 | Biol Reprod1997，57，6： | 1 |
| 6 | Deoxysugars in glycopeptide antibiotics: Enzymatic synthesis of TDP-L-epivancosamine in chloroeremomycin biosynthesis显示文摘 | Chen HW Thomas MG Hubbard BK | 2000 | Proceedings of the National Academy of Sciences of the United States of America2000，97，11： | 1 |
| 7 | Atherosclerosis of the ascending aorta, prevalence and role as an independent predictor of cerebrovascular events in cardiac patients显示文摘 | Victor GD Benico B Thomas HW | 1994 | Stroke1994，25，： | 1 |
| 8 | The breakdown of preexisting advanced glycation end products is associated with reduced renal fi- brosis in experimental diabetes 显示文摘 | FORBES JM THALLAS V THOMAS MC FOUNDS HW BURNS WC JERUMS G | 2003 | FASEB J2003，17，2： | 1 |
| 9 | Peanut Allergy, Peanut Allergens, and Methods for the Detection of Peanut Contamination in Food Products显示文摘 | Wen HW Wlodzimierz BW Thomas RD | 2007 | Comprehensive reviews in food science and food safety2007，6，2： | 1 |
| 10 | Fluorometric assessments of mitochondrial function and viability in cryopreserved bovine spermatozoa显示文摘 | Garner DL Thomas CA Joerg HW | 1997 | Biol Reprod1997，57，6： | 1 |
| 11 | Inhibition of CD26/dipeptidyl peptidase Ⅳ activity in vivo prolongs cardiac allograft survival in rat recipients显示文摘 | Korom S Meester ID Thomas HW | 1997 | Transplantation1997，63，： | 1 |
| 12 | A lead isotope distribution study in swine tissue using ICP-MS 显示文摘 | Thomas WM Ray HW Larry DB | 1999 | Atomic Spectroscopy1999，20，： | 1 |
| 13 | Processing of High- Density Submicrometer AI20 for New Applications显示文摘 | Krell A Blank P Ma HW Thomas H Manfred N | 2003 | Journal [''the American Ceramic Society2003，86，4： | 1 |
| 14 | Changes in pCO2 , Symptoms, and lung function of Asthma patients during capnometry-assisted breathing training 显示文摘 | Thomas R Alieia EM Frank HW | 2009 | Applied Psychophysiology and Biofeedback2009，34，： | 1 |
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