Background
Split liver transplantation can help with organ shortage and serve some of the small adults and pediatric recipients. There are some 200 DBD donors in Czech every year, very few pediatric ones. The pediatric recipients used to wait for either pediatric graft, only few received reduced graft. For these reasons the pediatric recipients used to wait for over 6 moths, within last 5 years for nearly 9 moths for transplant, some died while waiting

Material and Methods
Retrospective analysis of 10 split liver procedures performed at our institution. Initial experience with split liver at our institution in 1998 included two classical splits and three transplants, two pediatric recipients died from graft disfunction early after the the transplant, one adult lived for 6 years. One classical split was done in 2009, both recipients are alive. Split liver program has been set up at our unit in 2013.

Results
There were 7 split liver procedures performed in 2013, of those 6 classical for child and adult, one full for 2 adults. All split procedures we performed in vivo. All recipients except one child are alive and well, all the 13/14 recipients developed prompt graft function. Some 4 had biliary leak, treated with stent placement in 1 case. In one case we did full split for two fulminant liver failure patients, husband and wife who poisoned themselves by mistake with mushroom amanita phalloides. One of the recipients was AB0i on top of that, developed biliary leak, the original choledocho-choledocho anastomosis was converted to hepaticojejunostomy one week after the transplant. During 2013 the average waiting time for pediatric recipients has changed from 271 down to 13 days. There is only one child listed for transplantation nowadays.

Conclusion
Split liver transplantation has been introduced as program at our institution quite late. It helped to decrease significantly the waiting time for pediatric transplant, it may help to avoid deaths on the waiting list as well. Even full split liver for two adults is duable, in case of two fulminant liver failure patients it served both successfully.