Introduction : To expand donor pool, split liver transplantation has been conventionally performed for one adult and one pediatric patient. Application of this technique for two adult recipients under proper donor and recipient selection can produce remarkable impact on the waiting list.

Methods : Donor was 40 years old without any underlying disease and an estimated liver size was over 2000g without fatty change. One recipient was 50 years old with acute on chronic hepatitis B, model for end stage liver disease (MELD) score was 46 and a weight was 63kg. The other recipient was 54 years old with non-alcoholic steatohepatitis related liver cirrhosis and recurrent esophageal varix bleeding, MELD score was 15 and a weight was 47kg. We performed in situ splitting of the whole liver using LDLT technique. Parenchymal transaction was performed on middle hepatic vein line and modified right lobe graft and whole left lobe graft was generated.

Results : Graft-recipient weight ratio was 2.26 and 1.40, respectively. The cold ischemic time was 59 minutes and 178 minutes. Total operation time was 324 and 245 minutes. No vascular and biliary complications were occurred. One patient was discharged at 18 days after operation without any problem and the other patient was discharged at 40 days after operation because of ascites control and gastric ulcer bleeding. Both of the recipient are doing well with good liver function.

Conclusions : In situ split liver transplantation for 2 adult recipient using LDLT technique is feasible and a considerable options to expand donor pools under proper donor and recipient selection.