Published online Dec 21, 2018. doi: 10.3748/wjg.v24.i47.5312
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
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.
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.