Published online Oct 21, 2015. doi: 10.3748/wjg.v21.i39.11003
Peer-review started: May 6, 2015
First decision: June 2, 2015
Revised: June 27, 2015
Accepted: August 30, 2015
Article in press: August 30, 2015
Published online: October 21, 2015
Processing time: 174 Days and 2.5 Hours
Growing experience with the liver splitting technique and favorable results equivalent to those of whole liver transplant have led to wider application of split liver transplantation (SLT) for adult and pediatric recipients in the last decade. Conversely, SLT for two adult recipients remains a challenging surgical procedure and outcomes have yet to improve. Differences in organ shortages together with religious and ethical issues related to cadaveric organ donation have had an impact on the worldwide distribution of SLT. Despite technical refinements and a better understanding of the complex liver anatomy, SLT remains a technically and logistically demanding surgical procedure. This article reviews the surgical and clinical advances in this field of liver transplantation focusing on the role of SLT and the issues that may lead a further expansion of this complex surgical procedure.
Core tip: The transplantation community has made numerous efforts to expand the donor pool. While conventional split liver transplantation in which a child received the left lateral segment and an adult the right liver has proved an effective approach to increase organ availability, current outcomes after split liver transplantation for two adult recipients are conflicting. Ongoing surgical refinements and innovations have been reported and dedicated organ allocation policies proposed to encourage the more widespread application of this challenging procedure in the future.