A Novel Split Liver Protocol Using the Subnormothermic Oxygenated Circuit System in a Porcine Model of a Marginal Donor Procedure

•We investigated the split liver protocol using a subnormothermic oxygenated circuit system (SOCS) in a porcine model.•The sinusoidal spaces were widened in the cold storage (CS) group after implantation.•We have demonstrated the possibility of using SOCS with the split liver protocol.

BackgroundA merit of subnormothermic perfusion has been reported to preserve grafts from ischemic injury in animal models. The split liver technique is commonly performed to solve the shortage of liver grafts. However, there has been no study showing the effect of a split liver graft on subnormothermic perfusion. We herein investigated the split liver protocol using a subnormothermic oxygenated circuit system (SOCS).MethodsAuxiliary liver transplantation was performed in a porcine marginal donor model by using a SOCS. In the SOCS group, the portal vein and hepatic artery of the graft were cannulated, and the graft was perfused by SOCS. In the cold storage (CS) group, the graft was placed in cold preservation solution. In the preservation phase, the graft was split.ResultsThere were no significant differences in the biochemical markers between the SOCS and CS groups. In terms of the histology, the sinusoidal spaces were widened in the CS group 12 hours after implantation.ConclusionWe have demonstrated a possibility to use SOCS with the split liver protocol by using a porcine model. This split liver protocol using SOCS will extend the split liver criteria and rescue more patients from hepatic failure, including pediatric patients.