Korean J Transplant.  2023 Nov;37(Suppl 1):S287. 10.4285/ATW2023.F-9042.

Split liver transplantation for two adult recipients

• Han J
• Han YS

• KMID: 2551916
• DOI: http://doi.org/10.4285/ATW2023.F-9042

Abstract

Background
Split liver transplantation (SLT) is an important tool to reduce the paucity of donor organ and waitlist mortality. However, a SLT is technically challenging, may cause increased perioperative complications, and has potential risk that transform an excellent deceased donor organ into two marginal grafts. Therefore, critical evaluation of deceased organs suitable for split transplantation and careful screening of potential SLT recipients is warranted. We introduce one case that SLT for two adult recipients.
Methods
A 28-year-old woman was waiting for deceased donor liver transplantation. Her model for end-stage liver disease (MELD) score was 40 point and stayed intensive care unit with renal replacement treatment. Her height was 150 cm and weight were 52 kg, blood type was O+. Deceased donor allocation was done, 52-year-old male, 175 cm and 85 kg. In preoperative volumetry, donor whole liver volume was about 1,600 g and the liver volume was too large for recipient. At that time, a 56-year-old woman hospitalized due to massive pleural effusion and ascites because of alcoholic liver cirrhosis. Her MELD score was 12 points and she had no living liver donor. Her blood type was O+ and body weight was 52 kg. We decided SLT for two recipients, 28-year-old woman received modified right lobe with S1 graft, 56-year-old woman received extended left lobe graft.
Results
Modified right lobe graft with S1 graft was 1,030 g, extended left lobe graft was 670 g. The recipient who received right lobe graft had postoperative bleeding, resolved with angioembolization. There was no postoperative complication except that event.
Conclusions
Donor organ shortage and donor pool expansion is conundrum in liver transplantation. SLT is alternative for this problem, however, potential risk and ethical issue for graft quality because of split should be considered carefully.