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Published on: November 28, 2025
In situ split liver transplantation with celiac trunk allocation: technical evolution and outcomes supporting
Fahim Kanani1,2, Naheel Mahajna1, Aviad Gravetz1
1Department of Transplant Surgery, Rabin Medical Center, Beilinson Hospital, Affiliated to the Gray Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel.
Background:
Split liver transplantation (SLT) expands the donor pool, but optimal arterial configuration remains debated. We report outcomes of right-sided in situ SLT with systematic celiac trunk preservation with the right graft.
Methods:
Retrospective Multicentre analysis of 36 consecutive adult recipients of right-sided split grafts (2015-2025) with celiac trunk preservation. Primary outcomes included vascular complications, patient/graft survival, and comparison with published benchmarks.
Results:
Recipients (mean age 54.0 ± 12.6 years, 53% male) underwent SLT for HCV (30.6%), NASH (19.4%), and other etiologies. Major vascular complications occurred in 12/36 (33%) of cases, though life-threatening events remained uncommon: HAT 2.8%, postoperative PVT 5.6%, arterial stenosis 5.6%. Biliary complications occurred in 25% (ischemic 8.3%, technical 17%). Patient survival was 86% at 1 year and 81% at 3 years. Reoperation rate was 47%, primarily for biliary complications (17%) and intra-abdominal abscess (14%). Retransplantation rate was 11%.
Conclusion:
Right-sided SLT with celiac trunk preservation achieves excellent vascular outcomes, with both HAT (2.8%) and PVT (5.6%) rates meeting international benchmarks. These results strongly support this configuration as the preferred technical approach for in situ split liver transplantation.
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