A review of split liver transplantation with full right/left hemi-liver grafts for 2 adult recipients

Abstract

Liver transplantation has become a routine operation in many transplantation centers worldwide. However, liver graft availability fails to meet patient demands. Split liver transplantation (SPLT), which divides a deceased donor liver into 2 partial liver grafts, is a promising strategy for increasing graft availability for transplantation and ameliorating organ shortage to a certain degree. However, the transplantation community has not yet reached a consensus on SPLT because of the variable results. Specifically, SPLT for 2 adult recipients using full right/left hemi-liver grafts is clinically more challenging in terms of surgical technique and potential postoperative complications. Therefore, this review summarizes the current status of SPLT, focusing on the transplantation of adult recipients. Furthermore, the initiation of the SPLT program, donor allocation, surgical aspects, recipient outcomes, and obstacles to developing this procedure will be thoroughly discussed. This information might help provide an optimal strategy for implementing SPLT for 2 adult recipients among current transplantation societies. Meanwhile, potential obstacles to SPLT might be overcome in the near future with growing knowledge, experience, and refinement of surgical techniques. Ultimately, the widespread diffusion of SPLT may increase graft availability and mitigate organ donation shortages.

Figure 1

Illustration of the most common form of liver splitting for full hemi-liver grafts. (A) The transection line is performed along the Cantlie line at the right side of MHV. (B) The inferior vena cava is preserved for the right hemi-liver graft. The main hepatic arterial trunk, main portal vein, and the common bile duct are retained with the left hemi-liver graft during back-table preparation. The left hepatic vein and middle hepatic vein of the left hemi-liver graft are prepared as a common orifice for outflow reconstruction of graft implantation. The venous tributaries of MHV (V5 and V8) in the right hemi-liver graft should be reconstructed as appropriate. MHV = middle hepatic vein.

Figure 2

Split hemi-liver grafts. (A) The right hemi-liver graft. The venous tributaries of the segment 5 (V5) and 8 (V8) were reconstructed by venous graft. (B) The left-hemi-liver graft. Arrow indicates the celiac trunk of the graft. The cut surface of the hepatic parenchyma could be sealed with fibrin glue that could help to reduce bleeding after graft reperfusion.