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Split and Reduced-Size Liver Transplantation in Pediatric and Adult Recipients: Single-Center Outcomes and a
Madeline R Cloonan1, Shaheed Merani1, Elizabeth R Maginot1
1Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Background:
Pediatric liver transplant candidates, especially infants, have persistently high waitlist mortality. Deceased-donor technical variant grafts, including split liver transplantation (SLT) or reduced-size liver transplantation (RSLT), could expand access but remain underutilized. Whether splitting compromises the primary recipient's outcomes is uncertain.
Methods:
We conducted a retrospective, single-center study of deceased-donor technical variant liver transplants (2010-2025). Recipients were grouped as pediatric split (P-SLT), pediatric reduced-size (P-RSLT), and adult split (A-SLT). Primary outcomes were 1-year graft and patient survival; secondary outcomes included vascular complications, biliary complications, waitlist time, and waitlist mortality. A prespecified subgroup compared pediatric left lateral segment grafts by technique (split vs. reduced).
Results:
Fifty-four patients were included with 14 P-SLT, 26 P-RSLT, and 14 A-SLT cases. Vascular complications were infrequent (1 case each in P-SLT and P-RSLT). Biliary interventions were required during the index hospitalization in 14% (P-SLT), 19% (P-RSLT), and 21% (A-SLT) of recipients. One-year graft survival was 83% (P-SLT), 92% (P-RSLT), and 100% (A-SLT), with patient survival of 92%, 96%, and 100%, respectively. In pediatric LLS recipients, outcomes with split versus reduced grafts showed 1-year graft survival rates of 83% versus 100% (p = 0.333) and patient survival rates of 92% and 100%, respectively (p = 0.619), with no significant differences in complications. Pediatric waitlist during the study period had a mortality rate of 0.21 deaths per 1000 person-days (95% CI 0.04-0.37).
Conclusions:
At an experienced center, SLT and RSLT achieved favorable 1-year survival with low vascular morbidity.
