Abstract:
Due to the global shortage of organs, donation after circulatory death (DCD) has become an important source of liver grafts for liver transplantation. Nevertheless, its application is limited by warm ischemic injury and technical challenges associated with
in-situ splitting, and safe protocols for split liver transplantation with DCD grafts remain lacking at present. Normothermic regional perfusion (NRP) rapidly re-establishes oxygenated abdominal blood supply after circulatory arrest, effectively alleviating warm ischemic injury and creating stable operative conditions for in-situ splitting of DCD liver grafts. To date, liver splitting performed under NRP has achieved certain advances in dynamic graft assessment, monitoring of metabolic recovery, and decision-making for graft splitting. Accordingly, this article reviews the technical adaptability and preliminary clinical outcomes of
in-situ split liver transplantation with DCD grafts assisted by NRP, analyses the major obstacles to its popularization, and explores future research directions, so as to provide references for further clinical application of split liver transplantation.