First Split Liver Transplantation Using VitaSmart Hypothermic Machine Perfusion in the United States

Dynamic perfusion techniques are increasingly used in liver transplantation to improve graft preservation and support preimplantation assessment. Its reported use in split liver transplantation remains limited. We report the first use of the VitaSmart hypothermic perfusion device for graft preservation during ex situ split in the United States, resulting in the successful transplantation of a right trisection graft into an adult recipient and a left lateral section graft into a pediatric recipient.

A deceased donor liver was split into a right trisection graft for an adult recipient and a left lateral segment graft for a pediatric recipient. Both grafts underwent VitaSmart hypothermic oxygenated perfusion. Donor, graft, perfusion, operative, and early postoperative outcomes were reviewed. The adult recipient was a 63-year-old man with metabolic dysfunction-associated steatohepatitis cirrhosis. The pediatric recipient was a 4-year-old female with Joubert syndrome, congenital hepatic fibrosis with portal hypertension, and prior renal transplantation.

The right trisection graft weighed 1001 g, with an estimated graft-to-recipient weight ratio of 1.1. Implantation was performed with bicaval, portal vein, hepatic artery, and duct-to-duct biliary anastomoses. Reperfusion was uneventful, with uniform graft perfusion, normal intraoperative vascular waveforms, and bile production. The left lateral segment graft was implanted using piggyback caval implantation and Roux-en-Y biliary reconstruction. Postoperative Doppler demonstrated patent vessels. Early findings in both recipients demonstrated vascular patency and graft recovery.

This initial experience demonstrates the technical feasibility of incorporating VitaSmart hypothermic machine perfusion into split liver transplantation and highlights its potential role in expanding split graft utilization.