{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:04:48Z","timestamp":1790053488100,"version":"4.0.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Split liver transplantation (SLT) and controlled donation after circulatory death (cDCD) are two strategies used to expand the liver graft pool, but cDCD livers have traditionally been considered unsuitable for splitting because of warm ischemic injury, donor instability, and technical complexity. Normothermic regional perfusion (NRP) can restore oxygenated abdominal perfusion after death declaration and may create a physiologic window for\n                      <jats:italic>in situ<\/jats:italic>\n                      splitting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      We report two cDCD donation procedures in which NRP supported\n                      <jats:italic>in situ<\/jats:italic>\n                      SLT. Following withdrawal of life-sustaining treatment and death declaration, NRP was initiated before hilar dissection and parenchymal transection. The livers were divided into left lateral segment and right trisegment grafts, which were transplanted into four recipients. Functional donor warm ischemia times were 15 and 20\u00a0min, and NRP durations were 154 and 235\u00a0min. During NRP, lactate levels decreased substantially in both donors (from 6.6 to 1.2 mmol\/L and from 9.5 to 4.1 mmol\/L, respectively), with concurrent pH normalization. All recipients had functioning grafts at last follow-up (17.2\u201320.9 months). One infant developed early allograft dysfunction in association with hepatic artery thrombosis and underwent successful revascularization. No recipient developed primary nonfunction, graft loss, or a clinically diagnosed biliary complication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This case series supports the technical feasibility of NRP-assisted\n                      <jats:italic>in situ<\/jats:italic>\n                      SLT from cDCD donors and documents encouraging intermediate-term graft function. The small sample does not establish safety or comparative effectiveness. Larger studies with standardized viability assessment and extended vascular and biliary follow-up are required.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1933200","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:22:29Z","timestamp":1790050949000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: In situ split liver transplantation from controlled donation after circulatory death donors assisted by normothermic regional perfusion: a case series"],"prefix":"10.3389","volume":"17","author":[{"given":"Jisan","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Liver Transplantation, First Central Hospital of Tianjin Medical University","place":["Tianjin, China"]},{"name":"Tianjin Key Laboratory of Molecular Diagnosis and Treatment of Liver Cancer, Tianjin First Central Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Liver Transplantation, First Central Hospital of Tianjin Medical University","place":["Tianjin, China"]},{"name":"Tianjin Key Laboratory of Molecular Diagnosis and Treatment of Liver Cancer, Tianjin First Central Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haizhou","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Liver Transplantation, First Central Hospital of Tianjin Medical University","place":["Tianjin, China"]},{"name":"Tianjin Key Laboratory of Molecular Diagnosis and Treatment of Liver Cancer, Tianjin First Central Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wentao","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Liver Transplantation, First Central Hospital of Tianjin Medical University","place":["Tianjin, China"]},{"name":"Tianjin Key Laboratory of Molecular Diagnosis and Treatment of Liver Cancer, Tianjin First Central Hospital","place":["Tianjin, China"]},{"name":"Institute of Transplantation Medicine, Nankai University","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/hep.0000000000000873","article-title":"The future of liver transplantation","volume":"80","author":"Feng","year":"2024","journal-title":"Hepatology"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14211","article-title":"Evolving utilization of donation after circulatory death livers in liver transplantation: The day of DCD has come","volume":"35","author":"Haque","year":"2021","journal-title":"Clin Transplant"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.01.025","article-title":"Utilization of livers donated after circulatory death for transplantation - An international comparison","volume":"78","author":"Eden","year":"2023","journal-title":"J Hepatol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199903000-00003","article-title":"Split liver transplantation","volume":"229","author":"Busuttil","year":"1999","journal-title":"Ann Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"283\u201390","DOI":"10.1016\/s0022-3468(00)90026-5","article-title":"Split-liver transplantation: a comparison of ex vivo and in situ techniques","volume":"35","author":"Reyes","year":"2000","journal-title":"J Pediatr Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i39.11003","article-title":"Current status and perspectives in split liver transplantation","volume":"21","author":"Lauterio","year":"2015","journal-title":"World J Gastroenterol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/tp.0000000000005143","article-title":"Normothermic regional perfusion in controlled donation after the circulatory determination of death: understanding where the benefit lies","volume":"109","author":"Royo-Villanova","year":"2024","journal-title":"Transplantation"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2024.0520","article-title":"US liver transplant outcomes after normothermic regional perfusion vs standard super rapid recovery","volume":"159","author":"Brubaker","year":"2024","journal-title":"JAMA Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1097\/lvt.0000000000000434","article-title":"Normothermic regional perfusion in controlled DCD liver procurement: Outcomes of the Swedish national implementation protocol","volume":"30","author":"Bluhme","year":"2024","journal-title":"Liver Transpl"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14461","article-title":"In situ liver splitting under extracorporeal membrane oxygenation in brain-dead donor","volume":"18","author":"Assalino","year":"2017","journal-title":"Am J Transplant"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1002\/ags3.12749","article-title":"Using extracorporeal membrane oxygenation in donations after cardiac death or brain death: A single-center experience and long-term outcome","volume":"8","author":"Hsieh","year":"2023","journal-title":"Ann Gastroenterol Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/lt.22091","article-title":"Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors","volume":"16","author":"Olthoff","year":"2010","journal-title":"Liver Transpl"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/lt.26512","article-title":"Donor eligibility criteria and liver graft acceptance criteria during normothermic regional perfusion: A systematic review","volume":"28","author":"Schurink","year":"2022","journal-title":"Liver Transpl"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.12.013","article-title":"Normothermic regional perfusion vs. super-rapid recovery in controlled donation after circulatory death liver transplantation","volume":"70","author":"Hessheimer","year":"2018","journal-title":"J Hepatol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1097\/tp.0000000000003729","article-title":"Regulations and procurement surgery in DCD liver transplantation: expert consensus guidance from the international liver transplantation society","volume":"105","author":"Hessheimer","year":"2021","journal-title":"Transplantation"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-198906000-00011","article-title":"Hepatic artery thrombosis after pediatric liver transplantation--a medical or surgical event","volume":"47","author":"Mazzaferro","year":"1989","journal-title":"Transplantation"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2011.01580.x","article-title":"Prediction of early hepatic artery thrombosis by intraoperative color Doppler ultrasound in pediatric segmental liver transplantation","volume":"26","author":"Gu","year":"2012","journal-title":"Clin Transplant"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2026.1775491","article-title":"Piperacillin-tazobactam-associated thrombocytopenia with negative antiplatelet antibody testing: a case report and literature review","volume":"13","author":"Tian","year":"2026","journal-title":"Front Med (Lausanne)"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2026.1817103","article-title":"Thrombocytopenia and anemia associated with piperacillin-tazobactam: integrating clinical case series with FAERS disproportionality analysis","volume":"17","author":"Lu","year":"2026","journal-title":"Front Pharmacol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1933200\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:22:31Z","timestamp":1790050951000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1933200\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":19,"alternative-id":["10.3389\/fimmu.2026.1933200"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1933200","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"1933200"}}