Determining the Critical Graft-to-recipient Weight Ratio Threshold for Safety in Full-right/Full-left Split Liver Transplantation: A Multicentric Cohort Study

Split liver transplantation addresses organ shortage; however, the outcomes and risk factors full-right/full-left split liver transplantation (FR/FLSLT) require validation using multicenter data.This retrospective multicenter study included 132 FR/FLSLT recipients from five Chinese centers (May 2016-November 2024).Risk factors affecting survival were analyzed, stratified by graft-to-recipient weight ratio (GRWR) and risk factors.The overall 3-year recipient and graft survival rates were 84.1% and 81.8%, respectively.Recipients with a GRWR 1.15 exhibited significantly lower 3-year survival versus GRWR > 1.15 (58.1% vs. 91.7%recipient survival; 55.3% vs. 89.8%graft survival; P 52 and MELD score > 15 as independent mortality risk factors.In patients without risk factors, no mortality or graft-loss events were observed in the GRWR 1.15 group, but the small sample size (n = 3) limits the interpretation.However, with 1 risk factors, a GRWR 1.15 significantly increased mortality (HR 8.81, P 1.15 demonstrated favorable outcomes.GRWR 1.15 grafts may be considered for recipients without identified risk factors (age 52 , MELD score 15), and this requires further multicenter validation.