Extensive use of split liver for pediatric liver transplantation: A single‐center experience

The results of the extensive use of in situ liver splitting in a pediatric liver transplant program are presented. All referred donors were considered for split liver, and when the donor‐recipient body weight ratio (DRWR) was greater than 2, the grafts were split. A modified split‐liver technique was adopted when the DRWR was 2 or less. Eighty liver procurements were attempted and 72 (90%) were performed, enabling 65 children to receive 42 split, 22 whole, and 8 reduced‐size livers. The right portions of the grafts were transplanted by other centers into adults. Median patient waiting time was 22 days, with no mortality on the waiting list. After a median follow‐up of 14 months, overall patient and graft survival rates were 85% and 81%, respectively. Fifty‐eight children received a single allograft, whereas 7 children required retransplantation. Two‐year actuarial survival rates were 85% for split‐liver recipients, 84% for whole‐liver recipients, and 67% for reduced‐size liver recipients. Vascular complications developed in 18% of the patients, with no difference among the 3 groups with different technique. Biliary complications developed in 25% of the children, mainly in reduced‐size and split‐liver recipients. Patient and graft survival rates for right split‐liver grafts were 84% and 79%, respectively. Adopting a liberal policy of liver splitting provides allografts of optimal quality for pediatric transplantation, allowing a dramatic decrease in the waiting list time. The in situ split‐liver technique should be considered the method of choice for expanding the cadaveric liver donor pool.