*Purpose: Split liver transplantation (SLT) is an accepted surgical strategy to decrease waitlist mortality for pediatric recipients, concerns regarding increased morbidity right tri-segment graft (RTG) recipients have hampered wider application of SLT. The aim of the present study was to compare the outcomes of split vs whole liver transplants (WLT) in adults and split vs living donor liver transplant (LDLT) in children since the implementation of a routine SLT policy and a LDLT program in Sub-Saharan Africa (SSA).

*Methods: We analysed prospective databases for the pediatric and adult liver transplant programs at our center. Between 2013-2018, a total of 378 liver transplants were performed. The outcomes of LLS SLT (n=36) were compared with LLS LDLT’s (n=62) and the outcomes of RTG SLT (n=27) were compared with WLT’s (n=166).

*Results: Forty children and 23 adults received SLT allografts (16%). Of the 40/140 (29%) children, all but 4 received LLS grafts the rest getting a RTG. In the LLS group, 1-and 5- year patient survivals were 81% and 80% respectively in the LDLT group and 79% and 76% in the SLT group (p=0.31). Similarly, there was no difference in graft survival between the two groups (p=). When adjusting for other covariates, those with a PELD/MELD score of 15-29 (vs <15) (p=0.028) and those with malnutrition (MUAC z-score <-2) had an increased risk of death (p=0.027). The 1-and 5- year patient survivals were 88% and 82% respectively in the WLT group and 83% and 79% in the RTG SLT group (p=0.20). Similarly, there was no difference in graft survival between the two groups(p=). Biliary complications were significantly higher in the RTG split graft group (p=0.0001, RR=2.95).

*Conclusions: In a resource limited setting such as our, SLT can provide suitable organs for children and still have acceptable outcomes in adults and larger children.

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