Introduction: Full-right-full-left split liver transplantation (FRFLSLT) has been proposed as an option to overcome organ shortage in adults.

Method: This study assessed the outcome of FRFLSLT comparing full-right (FR) vs full-left (FL) in adults (1998-2009) as reported to the United Network for Organ Sharing (UNOS/OPTN).Pediatric cases and right trisectoral allografts were excluded.

Results: There were 339 cases of FR and 68 FL. Compared to FR, recipients of FL were younger (52.5 vs 47.6), had lower BMI (24.1 vs 26.9), and were more likely to be female (77.3.6% vs 41.9%). Recipients of FL had longer length of stay (26.7 vs 19.5 day) and higher retransplantation rates (22.1% vs 9.7%). Compared to FR, FL had more infectious complications (29.4% vs 22.4%), and higher rates of technical complications (36.7% vs 14.4%).

The allograft survival for FL was significantly less compared to FR and there was a trend for inferior patient survival. Majority of cases (85%) were in-situ split. There was no difference in allograft survival based on the split technique (in-situ vs ex-situ). In Cox regression analysis, FL was associated with an increased risk for allograft failure (HR=2.6) and inferior patient survival (HR=1.7).

Conclusions: The outcomes of FL compared with FR were inferior. Further utilization of FRFLSLT should be revisited.

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