Background/Objectives: The shortage of liver grafts remains a major challenge in transplantation. Full-left-full-right (FLFR) split liver transplantation (SLT) expands the donor pool by providing two grafts for small adult recipients. However, prolonged cold ischemia time (CIT) and ischemia-reperfusion injury (IRI) limit its success. Methods: We report a case of FLFR SLT utilizing ex situ dual hypothermic oxygenated machine perfusion (DHOPE) to mitigate IRI and enhance graft viability. A brain-dead donor’s liver was split under continuous DHOPE, followed by simultaneous transplantation into two adult recipients. Results: Both recipients exhibited stable graft function at one-year follow-up. DHOPE effectively reduced CIT and optimized postoperative recovery, with no major complications beyond Clavien–Dindo Grade IIIb. Conclusions: This is the first reported FLFR SLT using ex situ DHOPE for two adult recipients, demonstrating its feasibility in reducing CIT and improving outcomes. Machine perfusion may become a standard in FLFR SLT.

Background/Objectives : Pleomorphic liposarcoma (PLS) is a rare and aggressive subtype that accounts for 5% of all liposarcomas, with a 5-year survival rate of only 55-65%. Although PLS can metastasize in 30-50% of cases, isolated liver metastasis is extremely rare (0.5%) phenomenon. Surgical resection with histologically negative margins is considered the gold standard treatment in solitary metastasis of PLS. We present the second case reported worldwide of solitary liver metastasis in extremity pleomorphic liposarcoma patient. Methods : A 39-year-old male presented with metastasis in liver segment IVa following surgical resection of a primary PLS in his right lower leg. On physical examination, the liver protruded 1.5 cm below the costal margin without tenderness on palpation. The patient underwent hepatic segment IV resection with cholecystectomy, achieving negative margins. Postoperative recovery was uneventful, but disease recurrence occurred rapidly, with new metastases detected in the vertebral column at three months, followed by progression to the bones, peritoneum, lungs, and eye. Results : Despite multiple chemotherapy regimens, the patient succumbed to the disease 14 months after hepatic resection. Conclusions : Complete surgical resection offers the lowest recurrence rate for PLS but is most effective when disease is diagnosed at an early stage. This case highlights the aggressive nature of PLS and its unpredictable metastatic pattern. Given the rarity and diverse clinical course of this malignancy, further research and standardized management guidelines are urgently needed to improve outcomes for patients with this challenging disease.