The paradigm of split liver transplantation: a word of caution

Abstract

The first reports on split liver transplantation in the early 1980s gave rise to great expectations because it became clear that splitting a graft for two recipients was technically feasible [1, 2]. As a consequence, the shortage of donors for pediatric patients could be alleviated without detrimental effects on the pool for adult recipients [3]. Therefore, one should expect that a technique which increases the number of grafts for transplantation and thereby reduces waiting list time and mortality, especially in the field of pediatric transplantation, should have become a popular method of transplantation. However, the percentage of split liver transplantations of the total number of performed transplantations hardly increased in the following years. When analyzing data from the UNOS registry, split liver transplantation made up only about 5% of all performed pediatric liver transplantations in 1996 [4]. In 1999, data of Eurotransplant International and of the European Liver Transplant Registry showed that split liver transplantation made up between 4 and 9% of all performed liver transplantations [5, 6]. It is obvious that despite the practical and theoretical advantages of splitting livers, there seems still to be some restraint for using this technique in the majority of liver transplant centers. However, split liver transplantation is not only a necessity but it also deserves broader application because the results can be improved if certain precautions are taken. By analyzing a single center’s experience, this chapter aims at indicating some crucial factors for a successful split liver program.