An 82-year-old recipient of split liver transplantation worldwide: A case report

Abstract

Split liver transplantation (SLT) has become an indispensable method for expanding the donor liver pool. However, advanced age in recipients can have significant adverse effects on prognosis. We report the case of an 82-year-old man with chronic liver failure and polycystic liver disease who underwent in vivo split right triple lobe donor liver transplantation on October 29, 2021. The patient made a remarkable recovery and was discharged 1 month after surgery. To date, he has been followed up for 32 months, with favorable laboratory and imaging test results, and no significant abnormalities or complications. Currently, this patient may be the oldest SLT recipient in the world. With comprehensive preoperative evaluation, optimized surgical techniques, and individually tailored postoperative care, older adults can safely undergo SLT. Therefore, advanced age should not be considered an absolute contraindication for this procedure.

Keywords

Chronic liver failure / Older recipients / Polycystic liver disease / Split liver transplantation (SLT)

Authors’ contributions

Xiao Feng and Binsheng Fu contributed equally to this work and should be considered co-first authors. Xiao Feng: Writing e review & editing, Writing e original draft, Funding acquisition. Binsheng Fu: Writing e review & editing. Qing Yang: Resources. Kaining Zeng: Resources. Huimin Yi: Resources. Shuhong Yi: Supervision. Yang Yang: Supervision. All authors have read and approved the final manuscript.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Declaration of competing interest

Yang Yang is an executive associate editor for Liver Research and was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

Acknowledgments

The authors thank the patient, all the medical staff who helped him recuperate, and the donor who had donated the organ. This study is supported by Guangzhou Science and Technology Program of China (No.2023A04J1801).

References

[1] Bodzin AS, Baker TB. Liver transplantation today: where we are now and where we are going. Liver Transpl. 2018;24:1470e1475. https://doi.org/10.1002/lt.25320.

[2] Dababneh Y, Mousa OY. Liver Transplantation. Treasure Island (FL): StatPearls Publishing; 2024.

[3] Hackl C, Schmidt KM, Susal C, Dohler B, Zidek M, Schlitt HJ. Split liver trans-plantation: current developments. World J Gastroenterol. 2018;24:5312-5321. https://doi.org/10.3748/wjg.v24.i47.5312.

[4] Operative Surgical Group. Branch of surgery of Chinese medical association; Transplantation group, Branch of surgery of Chinese medical association. Chi-nese expert consensus on evaluation of donor and donor liver for split liver transplantation. Liver Res. 2022;6:59-65. https://doi.org/10.1016/j.livres.2022.03.002.

[5] Durand F, Levitsky J, Cauchy F, Gilgenkrantz H, Soubrane O, Francoz C. Age and liver transplantation. J Hepatol. 2019;70:745-758. https://doi.org/10.1016/j.jhep.2018.12.009.

[6] Goldberg DSCharlton M. Usefulness of liver transplantation in the elderly: the converging impact of risk and benefit. Gastroenterology. 2016;150:306-309. https://doi.org/10.1053/j.gastro.2015.12.020.

[7] Martin P, DiMartini A, Feng S, Brown Jr R, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59:1144-1165. https://doi.org/10.1002/hep.26972.

[8] Mousa OY, Nguyen JH, Ma Y, et al. Evolving role of liver transplantation in elderly recipients. Liver Transpl. 2019;25:1363-1374. https://doi.org/10.1002/lt.25589.

[9] Su F, Yu L, Berry K, et al. Aging of liver transplant registrants and recipients: trends and impact on waitlist outcomes, post-transplantation outcomes, and transplant-related survival benefit. Gastroenterology. 2016; 150:441- 453(e446). https://doi.org/10.1053/j.gastro.2015.10.043.

[10] Asrani SK, Saracino G, O’Leary JG, et al. Recipient characteristics and morbidity and mortality after liver transplantation. J Hepatol. 2018;69:43-50. https://doi.org/10.1016/j.jhep.2018.02.004.

[11] Lau NS, Jacques A, McCaughan G, Crawford M, Liu K, Pulitano C. Addressing the challenges of split liver transplantation through technical advances. A sys-tematic review. Transplant Rev (Orlando). 2021;35:100627. https://doi.org/10.1016/j.trre.2021.100627.