In situ splitting “full right - full left” for two adult recipients

Abstract

Ex situ split liver transplantation from cadaveric donors is an attractive concept allowing transplantation of two recipients with a single liver [1]. However, this technique did not gain wide acceptance because it was associated with increased morbidity and reduced graft survival [2]. The main drawbacks were a risk of bleeding from the cut surface, a high incidence of biliary complications and a prolonged cold ischemia time [2]. To overcome these problems, Rogiers et al. described an in situ splitting procedure which was associated with reduced cold ischemia time, incidence of biliary complications and primary delayed function as well as with improved graft and patient survival rates compared with the ex situ splitting [3]. However, whether performed ex situ or in situ, splitting techniques generate left grafts of limited size as it is usually agreed that the middle hepatic vein belongs to the right liver [4]. Transection is therefore either performed at the level of the falciform ligament [5, 6] or in the middle of segment IV [7] but with the middle hepatic vein being retained with the right graft. With these techniques, it has very seldom been possible to obtain a left graft large enough for an adult recipient.