Proof of concept: liver splitting during normothermic machine perfusion

Barney Stephenson, Glenn Bonney, Richard Laing, Ricky Bhogal, Francesca Marcon, Desley Neil, M Thamara P R Perera, Simon Afford, Hynek Mergental, Darius F Mirza

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Introduction: Despite utilizing extended criteria donors, there remains a shortage of livers for transplantation. No data exists on splitting donor livers with concurrent NMP-L.
Methods: A liver recovered from a donor after circulatory death was subjected to NMP-L using a red cell based fluid. During NMP-L, a ‘classical’ left lateral + right trisegmentectomy split was performed using an integrated bipolar/ultrasonic device.
After splitting, blood flow was confirmed using Doppler ultrasound in each lobe.
Results: Prior to splitting, flow rates were maintained physiologically. Lactate decreased from 13.9 to 3.0 mmol/L. Lactate before and after splitting were similar in the hepatic arteries, portal veins and IVC. Doppler ultrasound demonstrated arterial and venous waveforms in both lobes after splitting.
Conclusions: ‘Classical’ liver splitting during NMP-L is feasible, maintaining viability of both lobes. Establishing this procedure may attenuate cold ischaemic injury, allow pre-implantation monitoring of both grafts and facilitate logistics of
transplanting two grafts.
Original languageEnglish
Pages (from-to)1-6
JournalJournal of Surgical Case Reports
Early online date28 Mar 2018
Publication statusPublished - Mar 2018


  • Liver splitting
  • normothermic machine profusion
  • transplantation


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