Short-term outcomes and risk factors of full-size split liver transplantation: a single-center experience of 113 cases

Background: Full-size split liver transplantation (FSLT) offers an attractive way to expand the donor pool for adult patients. However, the efficacy and safety of FSLT remain under debate. Materials and Methods: One hundred and three recipients who underwent FSLT were enrolled, and 124 recipients who received whole-liver transplantation (WLT) were taken as a control group. Clinical data and short-term outcomes within 1 year posttransplantation from 2019 to 2023 were compared between the two groups. Survival rates were calculated using the Kaplan–Meier method and compared by the log-rank test. Meanwhile, propensity-score matching (PSM) using key prognostic factors was conducted and the results were compared. Univariate and multivariate logistic regression analyses were performed to identify risk factors for serious complications in FSLT. Results: Thirty-three (29.2%) and 25 (20.2%) recipients in FSLT and WLT experienced postoperative complications graded ≥ III, with no significant differences ( P = 0.106). However, biliary and vascular complications were more frequent in FSLT than in WLT (11.5% vs. 4.0% and 12.4% vs. 1.6%). The 3- and 6-month mortality rates in FSLT did not differ significantly from those in WLT (6.2% and 8.8% vs. 3.2% and 4.8%). The 1-year recipient (OS) and graft survival (GS) rates were 87.6% and 85.8% for FSLT, and 92.7% and 91.9% for WLT, with no significant differences. After PSM, the 1-year OS and GS were 81.3% and 81.3% for FSLT, and 90.6% and 90.6% for WLT ( P = 0.081). Multivariate analysis revealed that a graft with steatosis of 5%–10%, a MELD score ≥ 20, sarcopenia, a history of hepatectomy, and an operation time > 420 min were independent risk factors for the incidence of postoperative complications graded ≥ III in FSLT. Conclusions: FSLT remains a challenging procedure. However, the short-term outcomes of FSLT were acceptable compared with those of WLT, encouraging the use of this procedure to increase the donor pool whenever possible.