Outcomes with split liver transplantation in 106 recipients: The University of California, San Francisco, experience from 1993 to 2010

Background: Split liver transplantation (SLT) allows for expansion of the deceased donor pool. Objectives: To assess outcomes and the impact of splitting technique (in situ vs ex vivo) in SLT recipients. Design: Single-center retrospective review (September 18, 1993, to July 1, 2010). Setting: University medical center. Patients: One hundred six SLT recipients. Main Outcome Measures: Postoperative graft and patient survival and postoperative complications. Results: In adults, 1-, 5-, and 10-year overall patient survival was 93%, 77%, and 73%, respectively; overall graft survival was 89%, 76%, and 65%, respectively; ex vivo split patient survival was 93%, 85%, and 74%, respectively; and ex vivo graft survival was 86%, 77%, and 63%, respectively. In situ split patient and graft survival was 94% at 1 year and 75% at 5 years. Postoperative complications included biliary (29%), vascular (11%), unplanned reexploratory surgery (11%), incisional hernia (8%), small-for-size syndrome (n=1), need for shunt at the time of SLT (n=1), and primary nonfunction (n=1). In children, 1-, 5-, and 10-year overall patient survival was 84%, 75%, and 69%, respectively; overall graft survival was 77%, 63%, and 57%, respectively; ex vivo split patient survival was 83%, 73%, and 73%, respectively; and ex vivo graft survival was 75%, 59%, and 59%, respectively. In situ split patient and graft survival was 86% at 1 and 5 years. Postoperative complications included biliary (40%), vascular (26%), and primary nonfunction (n=1). Conclusions: Split liver transplantation remains an excellent option for expansion of the deceased donor pool for adult and pediatric populations. Postoperative morbidity remains high; however, this is justifiable owing to limited resources.