In situ splitting of a liver with middle hepatic vein anomaly

In situ liver splitting provides a way to expand the graft pool, minimize c old ischemia time, and improve hemostasis at the cut surface of the graft. Vascular anomalies of the liver may make the splitting procedure very diffi cult or even impossible to perform. The in situ splitting procedure, perfor med on a liver with a middle hepatic vein (MHV) anomaly, is described here. The MHV drained directly into the segment III vein within the hepatic pare nchyma instead of draining into the left hepatic vein to form the common tr unk. In situ splitting was performed during multiorgan procurement from a 3 3-year-old man who died of isolated cerebral trauma. The MHV was reconstruc ted on the back table to secure right graft venous drainage using an iliac vein graft. The resultant right graft, segments I and IV to VIII, and left graft, segments II and III, were transplanted successfully into an adult an d a child, respectively. The 2 transplant recipients are currently alive wi th normal hepatic function 20 months after transplantation.