Background: Liver transplantation (LT) in infants can be challenging due to small size and small vasculature. Although both whole LT (WLT) and split LT (SLT) have been described in these patients, head-to-head comparison of these techniques is lacking, especially in infants [1,2].
Methods: We retrospectively analyzed the records of all patients with age < 1 year at Indiana University School of Medicine between 2003 and 2022. In 2016, surgical technique was modified and majority of SLT (83%) were performed 2016 onwards. For this reason, a subgroup analysis was performed in LT between 2016 to 2022 (Era II) and early outcomes were compared. In Era II, all SLT were left lateral segment grafts split in-situ.
Results: A total of 38 infants were transplanted, with 23 WLT, 15 SLT. The median follow-up time was 51.2 months. For the entire cohort, one-year patient survival was 82% and 100% respectively, and one-year graft survival was 78.2% and 100% respectively. Era II included a total of 24 infants, with 13 WLT and 11 SLT. Donor and recipient characteristics and outcomes of Era II are summarized in Table 1. Early allograft dysfunction, primary nonfunction and hepatic artery thrombosis developed more frequently in the WLT group. One-year graft survival was numerically higher (100% vs. 77%; p=0.11) in the SLT group (Figure 1). There were two early deaths (2 & 4 days) in the WLT group; one from PNF and another from cardiogenic shock. There were no other biliary complications in this cohort.
Conclusions: In infants, left lateral segment SLT is associated with a trend towards superior outcomes as compared to WLT. Larger studies with homogeneous practices are required.