*Purpose: Split liver transplantation (SLT) is a strategy to address organ shortage, but is technically more demanding than whole liver transplants.

*Methods: SLTs conducted at a single-center from 2010-2019 were identified, and patient data was obtained through retrospective review of the electronic medical record. Kaplan-Meier analysis assessed primary outcomes of 1-year graft and patient survival.

*Results: Thirty-seven SLTs occurred during the study period. Twenty-four deceased donors donated 21 right lobes for an adult recipient and 16 left lateral segment (LLS) grafts for a pediatric recipient. 16/24 (67%) donors were pediatric donors (age<18). Among the pediatric donors, median age was 16 (13-17) years. Among adult donors, median age was 27 (19-36). Recipient data is displayed in Table 1. Among the pediatric recipients median PELD score was 45 (8-53) and 6 patients were status 1b on the list. In total, 81% (30/37) SLTs were performed after the introduction of the pediatric program in 2016. Thirteen donor livers were split with both grafts allocated and used at our center: the LLS used for a pediatric recipient and the right lobe for an adult, resulting in 26/37 transplants (70.3%). Twelve (92%) of these splits (24 SLTs) occurred after the introduction of the pediatric program in 2016. Median follow-up was 548 (10-3145) days. Of the 24 recipients with at least 1-year follow-up, graft and patient survival were 96% and 100%, respectively.

*Conclusions: The introduction of a pediatric liver transplant program resulted in more than a 4-fold increase in the number of SLTs performed at our center. Both split grafts from a single donor whole liver were allocated and used at our center, accounting for 26 of the 37 overall SLTs. Of those 26, 13 were performed in adults with excellent results. Moreover, pediatric SLT were performed in patients with high status achieving 100% graft and patient survival with zero waitlist mortality.

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