One liver for two adults: in situ split liver transplantation for two adult recipients.

To expand the donor pool, in the last 10 years surgical investigators have developed new procedures that brought liver grafting in the era of segmental transplantation. The evolution of this technique passed trough cut-down liver graft, ex-situ split liver, pediatric living related liver transplantation, and in-situ split liver (ISSL). Although this procedure has improved dramatically the global survival of pediatric recipient, they did not ameliorate the situation for adults. Splitting procedures were performed in four heart-beating donors hemodynamically stable and eligible for ISSL. In all cases the procedures took place outside our institution along multiorgan harvesting. The ISSL procedure took a mean time of 3 hours and 13 minutes (range 2 hours 45 minutes to 3 hours 45 minutes) with a mean blood loss of 950 mL (range 300 to 1500 mL). The recipient of the right graft of the last pair had good functional recovery and was discharged on POD 32 while the left graft recipient underwent retransplantation on POD 4 for primary nonfunction and was discharged from hospital on POD 59. They are both alive with a good hepatic function at 10 months after transplantation. The graft survival rate was 72%, and patient survival was 87.5%. We believe that this ISSL technique together with shorter ischemic time and an effective sharing policy, could significantly improve the donor pool for adults recipients.