Split liver transplantation for two adult recipients

We report a case of split liver transplantation for two adult recipients. The liver graft (1285 g) was split on the backtable into a right lobe graft (900 g, containing the inferior vena cava and middle hepatic vein) and a left lobe graft (385 g). The right lobe graft was implanted into a patient with hepatitis B cirrhosis uneventfully. The left lobe graft was implanted into a patient with familial amyloid polyneuropathy, but was met with massive bleeding from the transection surface and congestion of segment 4. The dusky appearance of segment 4 disappeared after hepatic artery anastomosis, but Doppler ultrasonography showed reverse blood flow in the segment 4 portal vein. Both patients survived the operation. The case illustrated that a left lobe graft without the middle hepatic vein could be problematic. To benefit two adults with chronic liver diseases, a better design of hepatic vein drainage of segment 4 in the left lobe graft and segment 5 and 8 in the right lobe graft is required.