In situ split liver transplantation can be accomplished without complications and provides results that are superior to those obtained previously with ex vivo methods. It abolishes ex vivo benching and prolonged ischemia times and provides two optimal grafts with hemostasis accomplished. This technique decreases pediatric waiting time and allows adult recipients to receive right-sided grafts safely. In situ splitting is the method of choice for expanding the cadaveric liver donor pool.

The hepatopulmonary syndrome (HPS), consisting of elevated alveolar-arterial oxygen gradient and intrapulmonary vascular abnormalities in the presence of advanced liver disease, is associated with high mortality. Liver transplantation (LT) has been used for the treatment of HPS; however, the success of LT for the treatment of HPS is not uniformly documented. We reviewed our experience over a 5-year period and identified eight adult patients with incapacitating respiratory symptoms compatible with HPS. Inclusion criteria included hypoxemia, normal lung volumes, reduced oxygen diffusing capacity (D L CO), and the presence of intrapulmonary shunting. Underlying liver disease was caused by hepatitis C (2 patients), primary biliary cirrhosis (1 patient), cryptogenic cirrhosis (1 patient), alcohol (2 patients), and hepatitis C with alcohol P atients with chronic advanced liver disease frequently show abnormalities in numerous organs. For example, renal insufficiency (hepatorenal syndrome) and peripheral arteriovenous shunting are widely recognized sequelae of cirrhosis. Less often recognized are the defects in pulmonary gas exchange observed with liver disease. A hepatopulmonary syndrome (HPS) has been described and encompasses a specific group of patients with severe liver disease and without cardiorespiratory disease who develop impaired gas exchange because of intrapulmonary vasodilatation (IPVD).In the past, hypoxemia was considered an absolute contraindication to liver transplantation (LT) 1 because of the operative and perioperative complications that arise in patients with gas exchange abnormalities. As the recognition of and experience with HPS has increased, concepts regarding indications LT for transplantation have come full circle, and it has been suggested that, in the face of otherwise stable liver disease, symptomatic HPS in and of itself may constitute an indication for LT. The role for transplantation in HPS is supported by the observation that the metabolic defects responsible for the pulmonary manifestations of HPS clearly are hepatic in origin, progressive, and, at present, refractory to medical management. However, the success of LT for the treatment of HPS is not uniformly documented.In the current study, we reviewed our single-center experience of eight patients with diagnosed HPS evaluated for LT, and report their long-term outcome and complications. Experimental Procedures Preoperative EvaluationAll patients were referred to UCLA for liver transplantation (LT) routinely undergo pulmonary function

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