As most commonly performed, split-liver transplantation (SLT) involves the division of donor liver from a deceased adult between a pediatric recipient and an adult recipient to maximize the benefit of each available donor organ.
Split-liver transplantation takes advantage of the knowledge gained in reduced-liver transplantation to increase the organ supply by using the right lobe or tri-segmental graft that remains after the left lateral segment or left lobe is removed for a pediatric recipient. Split-liver transplantation has now been applied in all patient groups, including status 1 patients and patients requiring re-transplantation. In the young pediatric population, split-liver transplantation or reduced-liver transplantation has become an increasingly frequent procedure.
Two approaches are available to generate split-liver allografts: ex vivo, in which the organ is removed from the donor and divided on the back table after the organ has been flushed and cooled, and in situ, in which the dissection and parenchymal division is performed in the donor while the organs are still being perfused.
Cooperation between different surgical teams is crucial, and the decision to proceed to in situ splitting should be based on the stability of the donor's condition and on the conditions of all waiting recipients. In general, acceptable outcomes can be achieved by using either approach.
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