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World J Gastroenterol. Dec 21, 2018; 24(47): 5312-5321
Published online Dec 21, 2018. doi: 10.3748/wjg.v24.i47.5312
Split liver transplantation: Current developments
Christina Hackl, Katharina M Schmidt, Caner Süsal, Bernd Döhler, Martin Zidek, Hans J Schlitt
Christina Hackl, Katharina M Schmidt, Martin Zidek, Hans J Schlitt, Department of Surgery, University Hospital Regensburg, Regensburg 93053, Germany
Caner Süsal, Bernd Döhler, Collaborative Transplant Study (CTS), Institute of Immunology, Heidelberg University, Heidelberg 69120, Germany
Author contributions: Hackl C contributed to conception and design, acquisition of data, drafting the article, critical revision for important intellectual content, and final approval of the version to be published; Schmidt KM and Zidek M contributed to conception and design, critical revision for important intellectual content, and final approval of the version to be published; Süsal C and Döhler B contributed to acquisition of data, critical revision for important intellectual content, and final approval of the version to be published; Schlitt HJ contributed to conception and design, acquisition of data, drafting the article, critical revision for important intellectual content, and final approval of the version to be published.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Christina Hackl, MD, Department of Surgery, University Medical Center Regensburg, Franz Josef Strauss Allee 11, Regensburg 93053, Germany. christina.hackl@ukr.de
Telephone: +49-941-94416806 Fax: +49-941-9446802
Received: July 9, 2018
Peer-review started: July 10, 2018
First decision: July 18, 2018
Revised: October 9, 2018
Accepted: October 21, 2018
Article in press: October 21, 2018
Published online: December 21, 2018
Abstract

In 1988, Rudolf Pichlmayr pioneered split liver transplantation (SLT), enabling the transplantation of one donor liver into two recipients - one pediatric and one adult patient. In the same year, Henri Bismuth and colleagues performed the first full right/full left split procedure with two adult recipients. Both splitting techniques were rapidly adopted within the transplant community. However, a SLT is technically demanding, may cause increased perioperative complications, and may potentially transform an excellent deceased donor organ into two marginal quality grafts. Thus, crucial evaluation of donor organs suitable for splitting and careful screening of potential SLT recipients is warranted. Furthermore, the logistic background of the splitting procedure as well as the organ allocation policy must be adapted to further increase the number and the safety of SLT. Under defined circumstances, in selected patients and at experienced transplant centers, SLT outcomes can be similar to those obtained in full organ LT. Thus, SLT is an important tool to reduce the donor organ shortage and waitlist mortality, especially for pediatric patients and small adults. The present review gives an overview of technical aspects, current developments, and clinical outcomes of SLT.

Keywords: Liver transplantation, Organ shortage, In situ split, Extended right lobe, Left lateral lobe, Living donor

Core tip: As of today, split liver transplantation (SLT) is a widely adopted but yet technically demanding approach to enable liver transplantation especially in very young recipients, and to reduce organ shortage and waitlist mortality. In contrast to full organ liver transplantation, many technical evaluations concerning the donor organ, the recipient, as well as the splitting procedure and the organ allocation policy, must be considered before a SLT can safely be performed. The present review gives insight into current controversies, technical challenges, and clinical outcomes of SLT.