Introduction: Split liver transplantation expands the deceased donor pool for pediatric populations.

Objectives: To assess if organ sharing with other institutes affects outcomes in pediatric split liver transplantation

Materials and methods: Single-center retrospective analysis of data of twenty four pediatric patients who underwent split liver transplantation in period between January, 2006 and December, 2014. We identified two groups: group A (those who shared organs with patients in our institute) and group B (those who shared organs with patients in other institutes)

Results: Median age of our patients was 1.91 (Range: 0.45-10.61) year. 58.3% of them were female. Each group included 50% of the patients.  Overall patient survival was 95.8% while overall graft survival was 83.3%. Patient survival was 100% for group A versus 91.7% for group B (P= 0.317). Graft survival was 100% for group A versus 66.7% for group B (P= 0.039).

Postoperative complications included biliary complications (41.7% in group A vs 50% in group B, P=0.682), vascular flow complications ( 8.3% in group A vs 41.7% in group B, P=0.059) ,postoperative bleeding (16.7% in group A vs 25% in group B, P =0.615), graft dysfunction (0% in group A vs 16.7% in group B, P =0.140). High grade Clavien-Dindo complications  were 0% in group A vs 25 % in group B, P= 0.064.

Although no significant difference in median hospital stay, it was longer in group B compared to group A (  29 (13-260) vs 13 (8-103), (P=0.100). Hospital death was 0% in group A while in group B we reported one case of hospital death, (P= 0.307).

Conclusions: Split liver transplantation is an excellent way allowing for expansion of the pool of organs for pediatric liver transplantation. Organ sharing between centers had significant poorer graft survival outcomes than organ sharing in between patients in the same center. Future larger studies are indicated to investigate these findings. This may change the organ allocation policy.