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Updated: May 12, 2026

A Novel Surgical Technique As a Foundation for In Vivo Partial Liver Engineering in Rat
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Ex vivo split-liver transplantation: the true right/left split.

Parsia A Vagefi1, Justin Parekh, Nancy L Ascher

  • 1Division of Transplant Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
|April 23, 2013
PubMed
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True right/left split-liver transplantation (SLT) is a viable option for increasing the donor pool. While offering good long-term survival, recipients of left lobe grafts experience higher complication rates.

Area of Science:

  • Hepatobiliary Surgery
  • Transplantation Medicine
  • Organ Donation

Background:

  • Split-liver transplantation (SLT) using left lateral segment or right trisegment techniques is established.
  • Limited data exists on the outcomes of true right/left ex vivo SLT.

Purpose of the Study:

  • To evaluate the outcomes of true right/left ex vivo split-liver transplantation.
  • To assess patient and graft survival rates and postoperative complications.

Main Methods:

  • Retrospective review of nine cases of true right/left ex vivo SLT performed between 1993 and 2010.
  • Analysis of 18 allografts derived from nine cadaveric liver grafts.

Main Results:

  • Ten-year patient survival was 74% for right lobe and 78% for left lobe recipients.

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Last Updated: May 12, 2026

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  • Ten-year graft survival was 74% for right lobe and 66% for left lobe recipients.
  • Left lobe recipients had higher rates of biliary and vascular complications, including hepatic artery thrombosis (HAT).

    • Conclusions:

    • True right/left ex vivo SLT is a feasible strategy to expand the donor liver pool, yielding excellent long-term survival.
    • Postoperative morbidity, particularly in left lobe graft recipients, is significant and requires careful consideration against transplant benefits.