Full-Left Full-Right Split Liver Transplantation

Full-left full-right split liver transplantation (FLFR SLT) is the division of a deceased donor liver into two similarly sized grafts and the subsequent transplantation of each of them into two adult-sized recipients. It may be considered an evolution from conventional SLT aiming at expanding the number of adult transplants and providing otherwise hardly available size-matched grafts for large children and adolescents. Its development has been supported by both growing experience in adult-to-adult living donor liver transplantation (LDLT) and advances in resectional liver surgery. Controversial outcomes have been reported so far, but most of the largest series worldwide have shown comparable results to those achieved by the most common approaches, namely whole liver transplantation (WLT) in Europe and the United States and LDLT in Asia. Actually, FLFR SLT is extremely demanding and its possible success is multifactorial. Not only optimal organs from the best donors should be used, but the most favorable donor-to-recipient matching should be pursued. Moreover, FLFR SLT requires high levels of technical skills and expertise in liver transplantation, usually typical of high-volume transplant and hepatobiliary surgery centers. Finally, a split liver-oriented allocation policy encouraging graft sharing appears crucial for its implementation. So, in the presence of the above-mentioned conditions, FLFR SLT may become a safe and effective strategy to increase the number of adult transplants and to facilitate transplantation of large children and adolescents.