To investigate perioperative cooperation management of in vivo and in vitro split liver transplantation (SLT), and evaluate the effect of two procedures on clinical prognosis of pediatric liver transplantation.

Clinical data of 30 children who underwent SLT in the Third Affiliated Hospital of Sun Yat-sen University from March 2022 to February 2023 were retrospectively analyzed. The informed consents of all children or (and) family guardians were obtained and the local ethical committee approval was received. Among them, 23 patients were male and 7 female, aged from 0 to 8.0 years, with a median age of 2.8 years. According to different surgical procedures, all children were divided into the in vivo SLT group (n=16) and in vitro SLT group (n=14). Perioperative cooperation measures for two surgical procedures were compared. The effects of two surgical procedures upon early liver and kidney function and prognosis of liver transplantation recipients were evaluated. Skewed distribution data such as cold ischemia time were compared by rank-sum test. The survival rates between two groups were compared by Fisher's exact test.

Compared with the in vitro SLT group, the procedures were more complicated, the number of surgeons and the amount of medical instruments, devices and consumables were higher in the in vivo SLT group. In the in vivo SLT group, the median cold ischemia time was 176 (149,244) min, significantly shorter than 366 (275,418) min in the in vitro SLT group (Z=-3.576, P<0.05). In the in vivo SLT group, the total postoperative expense was 14.8 (13.9,16.2)×10⁴ Yuan, significantly less than 19.1(15.2, 23.5)×10⁴ Yuan in the in vitro SLT group (Z=-2.079, P<0.05). In the in vivo SLT group, AST, ALT and Scr levels were recovered faster in the early stage after SLT. The follow-up time was 10-20 months, and the median follow-up time was 16 months. Postoperative arterial embolism occurred in 1 case in each group. Bile leakage occurred in 1 case in the in vivo SLT group. Two children died in the in vitro SLT group. In the in vivo SLT group, the 1-year survival rate was 100% (16/16) and 86% (12/14) in the in vitro SLT group, and the difference was not statistically significant (P=0.209).

Compared with in vitro SLT, in vivo SLT has higher requirements in terms of surgeons, surgical instruments and consumables. However, in vivo SLT possesses significant advantages in shortening cold ischemia time of the liver, accelerating early recovery of liver and kidney function and reducing total medical expense.