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Peer-reviewedCC BYPediatric transplantation

First Split Liver Transplantation Using VitaSmart Hypothermic Machine Perfusion in the United States.

  • Anastasia M Kahan1,2
  • Francisca van der Schyff1,2
  • Todd Robinson3
  • Ivan Rodriguez3
  • Tavis Shaw3
  • Enoch Zenger3
  • M Kyle Jensen4
  • Jean F Botha1,2,3
  • Zachary J Kastenberg1,2
4 affiliations
  1. 1Division of Pediatric Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
  2. 2Primary Children's Hospital, Intermountain Health, Salt Lake City, Utah, USA.
  3. 3Department of Surgery, Abdominal Transplant Service, Intermountain Medical Center, Intermountain Health, Murray, Utah, USA.
  4. 4Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
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Abstract

Background

Dynamic perfusion techniques are increasingly used in liver transplantation to improve graft preservation and support preimplantation assessment. Its reported use in split liver transplantation remains limited. We report the first use of the VitaSmart hypothermic perfusion device for graft preservation during ex situ split in the United States, resulting in the successful transplantation of a right trisection graft into an adult recipient and a left lateral section graft into a pediatric recipient.Methods

A deceased donor liver was split into a right trisection graft for an adult recipient and a left lateral segment graft for a pediatric recipient. Both grafts underwent VitaSmart hypothermic oxygenated perfusion. Donor, graft, perfusion, operative, and early postoperative outcomes were reviewed. The adult recipient was a 63-year-old man with metabolic dysfunction-associated steatohepatitis cirrhosis. The pediatric recipient was a 4-year-old female with Joubert syndrome, congenital hepatic fibrosis with portal hypertension, and prior renal transplantation.Results

The right trisection graft weighed 1001 g, with an estimated graft-to-recipient weight ratio of 1.1. Implantation was performed with bicaval, portal vein, hepatic artery, and duct-to-duct biliary anastomoses. Reperfusion was uneventful, with uniform graft perfusion, normal intraoperative vascular waveforms, and bile production. The left lateral segment graft was implanted using piggyback caval implantation and Roux-en-Y biliary reconstruction. Postoperative Doppler demonstrated patent vessels. Early findings in both recipients demonstrated vascular patency and graft recovery.Conclusions

This initial experience demonstrates the technical feasibility of incorporating VitaSmart hypothermic machine perfusion into split liver transplantation and highlights its potential role in expanding split graft utilization.

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  5. Expanding the Donor Pool in Pediatric Transplantations: Successful Domino Liver Transplantation From the Youngest Reported Pediatric DCD Donor Using Normothermic Regional Perfusion in the United States
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Cite

BibTeXRIS
BibTeX
@article{kahan2026first,
  title = {{First Split Liver Transplantation Using VitaSmart Hypothermic Machine Perfusion in the United States.}},
  author = {Anastasia M Kahan and Francisca van der Schyff and Todd Robinson and Ivan Rodriguez and Tavis Shaw and Enoch Zenger and M Kyle Jensen and Jean F Botha and Zachary J Kastenberg},
  journal = {Pediatric transplantation},
  year = {2026},
  month = oct,
  doi = {10.1111/petr.70504},
  url = {https://europepmc.org/article/MED/42876352},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - First Split Liver Transplantation Using VitaSmart Hypothermic Machine Perfusion in the United States.
AU  - Anastasia M Kahan
AU  - Francisca van der Schyff
AU  - Todd Robinson
AU  - Ivan Rodriguez
AU  - Tavis Shaw
AU  - Enoch Zenger
AU  - M Kyle Jensen
AU  - Jean F Botha
AU  - Zachary J Kastenberg
PY  - 2026
DA  - 2026/10/01
JO  - Pediatric transplantation
DO  - 10.1111/petr.70504
UR  - https://europepmc.org/article/MED/42876352
AB  - Background  Dynamic perfusion techniques are increasingly used in liver transplantation to improve graft preservation and support preimplantation assessment. Its reported use in split liver transplantation remains limited. We report the first use of the VitaSmart hypothermic perfusion device for graft preservation during ex situ split in the United States, resulting in the successful transplantation of a right trisection graft into an adult recipient and a left lateral section graft into a pediatric recipient.Methods  A deceased donor liver was split into a right trisection graft for an adult recipient and a left lateral segment graft for a pediatric recipient. Both grafts underwent VitaSmart hypothermic oxygenated perfusion. Donor, graft, perfusion, operative, and early postoperative outcomes were reviewed. The adult recipient was a 63-year-old man with metabolic dysfunction-associated steatohepatitis cirrhosis. The pediatric recipient was a 4-year-old female with Joubert syndrome, congenital hepatic fibrosis with portal hypertension, and prior renal transplantation.Results  The right trisection graft weighed 1001 g, with an estimated graft-to-recipient weight ratio of 1.1. Implantation was performed with bicaval, portal vein, hepatic artery, and duct-to-duct biliary anastomoses. Reperfusion was uneventful, with uniform graft perfusion, normal intraoperative vascular waveforms, and bile production. The left lateral segment graft was implanted using piggyback caval implantation and Roux-en-Y biliary reconstruction. Postoperative Doppler demonstrated patent vessels. Early findings in both recipients demonstrated vascular patency and graft recovery.Conclusions  This initial experience demonstrates the technical feasibility of incorporating VitaSmart hypothermic machine perfusion into split liver transplantation and highlights its potential role in expanding split graft utilization.
SN  - 1397-3142
SN  - 1399-3046
ER  -