How to apply ex-vivo split liver transplantation safely and feasibly: A three-step approach

Table 1 Clinical data of 13 donor liver cases

No.	Gender	Age (yr)	Type of donation	Cause of death	Preoperative Na+ concentration (mmol/L)	Preoperative TB (μmol/L)	Preoperative ALT (U/L)	Preoperative AST (U/L)	ICU stay duration (d)
1	Male	31	DBD	Craniocerebral injury	143	57.80	37.0	41.0	3
2	Female	12	DBD	Hypoxic-ischemic encephalopathy	140	13.40	42.0	53.0	4
3	Female	42	DBD	Craniocerebral injury	146	50.80	45.0	83.0	5
4	Male	44	DBD	Cerebral hemorrhage	143	45.30	18.0	37.0	4
5	Male	36	DBD	Craniocerebral injury	150	13.80	131.0	172.0	4
6	Male	34	DBD	Cerebral hemorrhage	156	23.40	267.5	293.2	2
7	Male	12	DBD	Hypoxic-ischemic encephalopathy	136	13.00	43.3	93.1	11
8	Male	31	DBD	Cerebral hemorrhage	150	26.80	15.0	25.0	10
9	Male	25	DBD	Craniocerebral injury	143	54.50	177.0	83.0	4
10	Female	9	DBD	Hypoxic-ischemic encephalopathy	148	3.05	103.0	227.0	10
11	Male	8	DBD	Hypoxic-ischemic encephalopathy	149	10.21	22.7	22.9	4
12	Female	29	DBD	Cerebral hemorrhage	148	20.76	37.0	42.0	7
13	Male	40	DBD	Cerebral hemorrhage	132	12.20	166.0	85.0	5

DBD: Donation after brain death; TB: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Na⁺: Sodium ion; ICU: Intensive care unit.

Table 2 Clinical data comparison between split liver transplantation and whole liver transplantation cases

	Split liver transplantation (n = 25)	Whole liver transplantation (n = 81)	P value
Gender (male/female)	17/8	65/16	0.273
Age (yr)	1.83 (0.55, 43.00)	49 (40.50, 55.00)	0.001
Underlying diseases
Decompensated cirrhosis	5	48	0.001
Liver cancer	2	15	0.210
One-week postoperative indicators
TB	26.400 (12.950, 34.350)	28.250 (17.525, 48.925)	0.274
ALT	176.0 (81.5, 259.5)	73.5 (43.5, 115.5)	0.000
AST	42.00 (32.00, 79.00)	29.00 (20.25, 49.25)	0.004
GGT	139.0 (102.5, 227.5)	118.0 (64.0, 174.0)	0.117
Two-week postoperative indicators
TB	11.80 (7.95, 20.55)	20.80 (15.20, 26.30)	0.003
ALT	63.0 (29.5, 82.5)	40.0 (21.0, 82.0)	0.154
AST	41.5 (20.5, 61.5)	26.0 (17.0, 41.0)	0.014
GGT	81.0 (54.5, 182.5)	114 (56.0, 201.0)	0.528
Postoperative complications			0.584
Intra-abdominal bleeding	0	5
Hepatic artery thrombosis	1	3
Pulmonary infections	3	8
Abdominal infection	0	1
Bile leakage	0	0
Intestinal leakage	0	0
30-d postoperative mortality	0	1

TB: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase.