Liver transplantation

Split-liver transplantation, in which a deceased donor adult liver is divided into two functional grafts, became available in 1988 after its description by Rudolf Pichlmayer. In the current situation of organ/donor shortage, reduction techniques have been developed to make it possible for pediatric liver recipients to benefit from adult organ donation. Split-liver grafts are preferable to reduced grafts because this maximizes the donor organ pool. While in vivo split-liver transplant has the advantage of reducing cold ischemic time, it does increase significantly the duration of the donor operation, putting the patient at risk for intraoperative complications, with the possible theoretical risk of intraoperative donor death, and therefore loss of all allocated organs. The reduced graft comes with the main portal vein, the celiac axis, the main bile duct, and possibly the inferior vena cava, but most of these structures may be removed and only the branches to the lobe may be used at the time of implantation.