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World J Transplant. Sep 24, 2015; 5(3): 89-94
Published online Sep 24, 2015. doi: 10.5500/wjt.v5.i3.89
Split liver transplantation: What’s unique?
Aparna R Dalal
Aparna R Dalal, Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: Dalal AR authored the paper.
Conflict-of-interest statement: The author declares that there is no conflict of interests regarding publication of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Aparna R Dalal, MD, Assistant Professor, Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, New York, NY 10029, United States. aparna.dalal@mssm.edu
Telephone: +1-216-2722545 Fax: +1-206-4864610
Received: August 23, 2014
Peer-review started: August 25, 2014
First decision: December 17, 2014
Revised: December 26, 2014
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: September 24, 2015
Processing time: 397 Days and 9.5 Hours
Abstract

The intraoperative management of split liver transplantation (SLT) has some unique features as compared to routine whole liver transplantations. Only the liver has this special ability to regenerate that confers benefits in survival and quality of life for two instead of one by splitting livers. Primary graft dysfunction may result from small for size syndrome. Graft weight to recipient body weight ratio is significant for both trisegmental and hemiliver grafts. Intraoperative surgical techniques aim to reduce portal hyperperfusion and decrease venous portal pressure. Ischemic preconditioning can be instituted to protect against ischemic reperfusion injury which impacts graft regeneration. Advancement of the technique of SLT is essential as use of split cadaveric grafts expands the donor pool and potentially has an excellent future.

Keywords: Graft to recipient body weight ratio; Split liver transplantation; Small for size syndrome; Hemiliver grafts; Portal hyperperfusion

Core tip: The liver has a special ability to regenerate that confers benefits in survival and quality of life for two instead of one by splitting livers. Primary graft dysfunction may result from small for size syndrome. Graft weight to recipient body weight ratio is significant for both trisegmental and hemiliver grafts. Intraoperative surgical techniques aim to reduce portal hyperperfusion and decrease venous portal pressure. Ischemic preconditioning can be instituted to protect against ischemic reperfusion injury which impacts graft regeneration.