The concept and technique of the split liver in clinical transplantation.

Extreme scarcity of small pediatric donors makes a search necessary for technical variants to benefit infants and small children from the larger group of potential adolescent and adult donors. Three such technical variants are available for orthotopic transplantation. The reduced-size graft allows a weight ratio between donor and recipient of up to 4 to 6. The segmental graft allows transplantation of segments of livers from adult donors into infants and small children of up to a weight ratio of 8 to 9. The technique of the split liver, whereby one single donor liver is divided in such a way as to obtain two viable grafts for transplantation into two different recipients, is the most recent technical variant used to increase the flexibility of liver replacement and maximize the use of the donor liver pool. We report herein our two first cases of split liver with transplantation in four different recipients, with two long-term survivors. The described technique can also be useful in urgent adult transplantation.