To investigate the clinical application and efficacy of adult to adult split liver transplantation(SLT) with the middle hepatic vein fully split.

The clinical data of 2 patients received SLT with the middle hepatic vein of cadaver liver fully split in the Tianjin First Central Hospital on September 2010 were analyzed retrospectively. The total weight of liver graft was 960 g without any evidence of hepatic adipose infiltration. The 2 recipients were both female with the age of 41, 61 years old and their weight were 55 kg and 35 kg respectively. The protopathy were hepatocellular carcinoma (HCC) and primary biliary cirrhosis. The informed consents of the participants were obtained and the ethical committee approval was received. The donor liver was split following the Cantlie line to the main middle hepatic vein. The main middle hepatic vein was acutely split lengthways. Middle hepatic vein divides the liver into night and left lobes. The iliac vein of the same donor was used to rebuild as the middle hepatic veins of the left and right remnant liver. The 2 recipients received classic orthotopic liver transplantation of right lobe without venovenous bypass and piggy-back liver transplantation of left lobe respectively.

The cold ischemia time of liver grafts were 790 min and 740 min. The weight were 606 g and 354 g. The graft to recipient weight ratios (GRWR) were 1.12% and 1.01% respectively. The reconstructed middle hepatic vein in each hemi-liver graft showed no hemiliver venous outflow obstruction after the operation. The liver function of both recipients recovered well and no small-for-size syndrome was observed. The graft volume gained evidently 3 weeks after the operation compared with the preoperative graft and no outflow obstruction of the reconstructed middle hepatic veins was detected by multislice spiral computed tomography (MSCT). The recipients were followed up for 2 years. One recipient died of tumor recurrence one year after the operation, and the other still survived up till now.

Adult to adult SLT with the middle hepatic vein fully split can ensure complete venous outflow for both split liver grafts with maximal functional liver volume of grafts and decrease the morbidity of small-for-size syndrome.