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Updated: Aug 18, 2026
Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Right hemiliver transplant: results from living and cadaveric donors
A Giacomoni1, L De Carlis, A Lauterio
1Liver Transplant Unit, Niguarda Hospital, Milano, Italy. alex.giaco@libero.it
Insights
Right hemiliver transplants from living donors (LD) show better outcomes than those from cadaveric donors (CD). LD transplants had lower mortality and fewer complications, highlighting the importance of donor selection and logistics in liver transplantation.
Area of Science:
- Hepatology
- Transplantation Surgery
- Organ Donation
Background:
- Right hemiliver transplantation is a strategy to address organ shortages.
- Splitting cadaveric donor (CD) livers for two adult recipients remains controversial.
- Living donor (LD) right hemiliver transplantation is increasingly accepted.
Purpose of the Study:
- To compare the technical aspects and patient outcomes of right hemiliver transplantation from CD versus LD.
- To evaluate the feasibility and success rates of split liver transplantation.
Main Methods:
- A retrospective analysis of nine right hemiliver transplants from CD (segments 5-6-7-8) and 18 from LD.
- Comparison of patient and graft survival, complications, and technical outcomes between the two groups.
Main Results:
- Cadaveric donor (CD) group: 33% recipient mortality, 67% patient and graft survival (median follow-up 23 months), 55% early complications.
- Living donor (LD) group: 17% recipient mortality, 83% patient survival, 72% graft survival (median follow-up 8 months), 27% early complications.
- Higher morbidity and mortality observed in the CD group compared to the LD group.
Conclusions:
- Right hemiliver transplantation from LD yields better results than from CD.
- Factors contributing to better LD outcomes include donor evaluation, shorter ischemia time, and logistics.
- Recipient selection is critical due to high risks of poor function, technical issues, and infections in CD grafts.
Unlabelled:
Although right hemiliver transplant from living donors (LD) is gaining acceptance as a way to overcome the critical organ shortage, splitting a liver for two adults from cadaveric donor (CD) is still controversial.
Methods:
From May 1999 to August 2004 we performed nine right hemiliver transplants using segments 5-6-7-8 from CD and 18 from LD.
Results:
We compared the two procedures to evaluate both the technical aspects and the patients' outcomes. In the CD group, three recipients died (33%), two of whom were UNOS Status 2A. Patient and graft survivals were 67% (median follow-up: 23 months). Among the LD group, three recipients died (17%) and two were retransplanted; one because of arterial thrombosis and the other as a consequence of small-for-size syndrome. Patient and graft survivals were 83% and 72%, respectively (median follow-up: 8 months). There were five early complications in the CD group (55%) and five (27%) in the LD group. Two patients in the LD group experienced a late stenosis of the biliary anastomosis.
Discussion:
Data from our early experience show that better results are achieved by right hemiliver transplants from LD; the morbidity and mortality are higher among the CD group. We believe that this finding is probably a consequence of better preoperative donor evaluation, shorter ischemia time, better logistics, and learning curve. Recipient selection is crucial; this kind of graft is at high risk of poor function, technical complications, and infections. Further experience will help to clarify the reliability of right hemiliver transplants from CD.
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