Application of in Vivo Splitting Technique in Adult Liver Transplantation

Application of in Vivo Splitting Technique of Brain-dead Donor Liver in Adult Liver Transplantation

The feasibility of split liver transplantation (SLT) remains controversial. This study aimed to evaluate the outcomes of SLT in adult recipients and to identify specific areas of improvements. A retrospective analysis was conducted on adults who underwent full size SLT between January 2021 and December 2023. The short-term outcomes of these patients who underwent SLT were compared with those of patients who underwent whole liver transplantation (WLT) during the same period.

Inclusion Criteria:

• For the donor graft:

  1. age of 18-60 years;
  2. BMI of 19-28 kg/m2;
  3. hemodynamic stability or use of a single vasoactive drug with a small dosage (norepinephrine ≤ 0.1 μg/kg/min or dopamine ≤ 5 μg/kg/min);
  4. liver steatosis ≤ 10%;
  5. liver functional indicators (ALT, AST, total bilirubin quantification) ≤ 3 times the normal value;
  6. blood sodium ≤ 160 mmol/L;

For the SLT recipients

1. Patients who had registered in the China Organ Transplant Response Systems.
2. Initial liver transplantation.
3. Graft-to-Recipient Weight Ratio (GRWR) ≥ 1%.

Exclusion Criteria:

• For the donor graft

  1. uncontrollable infection
  2. significant vascular and biliary variation.

For the recipients

1. Severe portal hypertension.
2. Significant vascular variation.