Conventional split liver transplantation for two adult recipients: a recent experience in a single European center

Transplantation. 2009 Nov 15;88(9):1117-22. doi: 10.1097/TP.0b013e3181ba1096.


Background: Split liver transplantation (SLT) for two adult recipients is still considered a challenging procedure, especially when subjected to model for end-stage liver disease (MELD)-based allocation criteria.

Methods: Twenty-two SLTs were performed in adult recipients in a European center operating within a MELD-oriented system. Thirteen right-sided grafts and nine left-sided grafts were used. Right-sided grafts included 11 extended right grafts and two full right grafts. Left-sided grafts included six left lateral segment grafts and three full left grafts. Ninety-three percent of donors were allocated based on MELD score. Median graft-to-recipient body weight ratio was 1.53 (range 1.07-2.11) with right-sided grafts and 0.81 (range 0.67-1.11) with left-sided grafts. Liver cirrhosis (46%) and metabolic/genetic disorders (56%) were the main indications for transplant in recipients of right and left grafts, respectively.

Results: Overall patient and graft survival were 90% and 86%. Patient survival was 84% in recipients of right grafts and 100% in recipients of left grafts. Graft survival was 84% and 89%, respectively. Vascular and biliary complications occurred in 14% and 4% of cases. Postoperative serum levels of total bilirubin were significantly higher in recipients of left-sided grafts versus right-sided grafts on postoperative days 7 and 14. Prothrombin activity was significantly lower in recipients of left-sided grafts versus right-sided grafts on postoperative days 3 and 7.

Conclusions: SLT for two adult recipients can be successfully performed even using left lateral segments by assigning one graft according to MELD score, and with a more liberal allocation of the second graft.

MeSH terms

  • Adolescent
  • Adult
  • Bilirubin / blood
  • Follow-Up Studies
  • Functional Laterality
  • Graft Survival / physiology*
  • Hepatectomy / methods*
  • Humans
  • Liver / anatomy & histology*
  • Liver Failure / surgery*
  • Liver Transplantation / methods*
  • Liver Transplantation / physiology
  • Middle Aged
  • Patient Selection
  • Postoperative Complications / classification
  • Postoperative Complications / epidemiology
  • Prothrombin Time
  • Time Factors
  • Tissue Donors / statistics & numerical data
  • Tissue and Organ Harvesting / methods*
  • Treatment Outcome
  • Young Adult


  • Bilirubin