Introduction: Although split liver transplantation (SLT) maximises the utility of deceased donor livers and has excellent results, relatively few (8%) donor livers are split in Australia and New Zealand. Some splittable livers are transplanted as whole grafts because of concern about the outcome of SLT in sick recipients. The outcome of SLT was compared with whole liver transplantation (WLT) in a high acuity cohort.
Materials and Methods: Power calculations determined that 17 patients in each group would be required for a power of 0.8 to detect a 10% poorer outcome in the SLT group at a significance of 0.05.  Adult patients who underwent WLT by the Victorian Liver Transplant Unit from 1 July 2009 to 30 June 2019 using a liver that fulfilled split criteria but who were considered too sick to undergo SLT were matched using propensity score matching to patients of comparable acuity who underwent SLT. Variables included in determining the propensity score were retransplantation, medical status, fulminant hepatic failure and model for end-stage liver disease score. Patient and graft survival were compared using Kaplan Meier with log-rank analysis.
Results: There were 21 patients in each group. There was no significant difference between the groups in terms of donor age, donor cause of death, donation pathway, recipient age, disease, cold ischaemia time and the recipient factors included in matching. Patient (5-year survival SLT 93% vs WLT 83%, P = 0.607) and graft (5-year survival SLT 83% vs WLT 83%, P = 0.794).
Conclusion: SLT and WLT result in equivalent patient and graft survival in high acuity patients. Greater use of SLT in these patients will improve transplant utility.