{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T11:41:24Z","timestamp":1784806884092,"version":"3.55.0"},"reference-count":16,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,8,21]],"date-time":"2024-08-21T00:00:00Z","timestamp":1724198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pediatric liver transplantation for small recipients presents significant challenges, particularly in securing suitably sized donor organs. This case report illustrates the feasibility of performing an in\u00a0situ split procurement in an 18.5\u2010kg toddler, the smallest recorded case in the OPTN database to date, for a critically ill 8\u2010week\u2010old infant recipient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>An 8\u2010week\u2010old infant with severe hepatitis of unknown etiology was urgently listed as Status 1A. An organ offer from a 3.5\u2010year\u2010old donor, requiring a reduction procedure, became available 1939 nautical miles away. Instead of a back\u2010table reduction procedure, we performed an in\u00a0situ split to reduce cold ischemic time given the distance. The recipient surgery was started ahead of the organ's arrival, and the recipient was ready for graft implantation upon the organ's arrival, resulting in a total of 510\u2009min of cold ischemic time. Post\u2010operatively, the graft did not show signs of significant injury or dysfunction, which expedited recovery from her other medical conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In situ split liver procurement is an invaluable tool for pediatric centers as it effectively provides more graft options for pediatric patients on the waitlist. Additionally, in\u00a0situ split can offer significant benefits in optimizing recipient surgery, especially when the donor is located at an extreme distance. Despite these benefits, in\u00a0situ split is not currently widely utilized across transplant centers. Addressing the logistical challenges associated with this technique is crucial for broader implementation and improved patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14848","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T03:10:42Z","timestamp":1724296242000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pushing the Limits of In\u00a0Situ Split Liver Procurement to Overcome Donor Distance and Graft Size Challenges for 8\u2010Week\u2010Old Pediatric Recipient"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6026-5532","authenticated-orcid":false,"given":"Yong\u00a0K.","family":"Kwon","sequence":"first","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Washington  Seattle Washington USA"},{"name":"Division of Transplantation Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8227-2004","authenticated-orcid":false,"given":"Pamela\u00a0L.","family":"Valentino","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Pediatrics University of Washington School of Medicine, Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4936-5505","authenticated-orcid":false,"given":"Katelyn\u00a0M.","family":"Saarela","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Pediatrics University of Washington School of Medicine, Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle\u00a0R.","family":"Wendel","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Pediatrics University of Washington School of Medicine, Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4359-7102","authenticated-orcid":false,"given":"Evelyn\u00a0K.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Pediatrics University of Washington School of Medicine, Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel\u00a0M.","family":"Kaufman","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8052-7632","authenticated-orcid":false,"given":"Andre\u00a0A.\u00a0S.","family":"Dick","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Washington  Seattle Washington USA"},{"name":"Division of Transplantation Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8977-0815","authenticated-orcid":false,"given":"Patrick\u00a0J.","family":"Healey","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Washington  Seattle Washington USA"},{"name":"Division of Transplantation Seattle Children's Hospital  Seattle Washington 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