Split liver transplantation

Greater experience and improved outcomes in liver transplantation have necessarily led to longer waiting lists against a constantly limited donor pool. Split liver transplantation has been conceived as a means to increase the supply of liver grafts. The bipartition of a whole liver provides grafts for two recipients in a complex operation with equally complex manpower and logistical demands. The in situ technique of splitting offers advantages over the ex vivo technique, although after the time-dependent learning curve is overcome, they may theoretically be used interchangeably with acceptable outcomes. Aside from surgical expertise, donor characteristics and recipient pre-transplant status are risk factors for survival. This review will address the salient aspects of split liver transplantation, summarize the world experience with this procedure and describe the preliminary attempts in Asia.