Right split livers are definitely not marginal grafts: a propensity score analysis of a single centre cohort with very long-term follow-up

Sophie Chopinet; Emilie Grégoire; Mustapha Adham; Serban Puia-Negulescu; Emilie Bollon; Jean Hardwigsen; Jérôme Dumortier; Olivier Boillot

doi:10.1016/j.hpb.2026.01.004

Right split livers are definitely not marginal grafts: a propensity score analysis of a single centre cohort with very long-term follow-up

HPB (Oxford). 2026 Jan 13:S1365-182X(26)00004-3. doi: 10.1016/j.hpb.2026.01.004. Online ahead of print.

Authors

Sophie Chopinet¹, Emilie Grégoire², Mustapha Adham³, Serban Puia-Negulescu⁴, Emilie Bollon⁴, Jean Hardwigsen⁴, Jérôme Dumortier³, Olivier Boillot⁵

Affiliations

¹ Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France; Aix Marseille Univ, LIIE, Marseille, France; Aix Marseille Univ, CERIMED, Marseille, France. Electronic address: sophie.chopinet@ap-hm.fr.
² Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France; Aix Marseille Univ, LIIE, Marseille, France; Aix Marseille Univ, CERIMED, Marseille, France.
³ Department of Digestive Surgery, Transplantation Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
⁴ Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France.
⁵ Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France; Department of Digestive Surgery, Transplantation Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.

PMID: 41620348
DOI: 10.1016/j.hpb.2026.01.004

Abstract

Background: Split-derived right liver grafts are often considered marginal. This study aimed to compare the long-term outcomes of adult liver transplantation using either whole liver (WL) or right hemi-liver (RHL).

Methods: This single-center retrospective comparative study included liver transplants that were performed between 1991 and 2010.

Results: A total of 775 liver transplants were performed, including 70 RHL cases (9%). Donors were younger in the RHL group (25 ± 11 vs. 39 ± 16 years, p=0.001). Complications were similar between the RHL and WL groups, except for bilioma, more frequent in RHL group (11.4% vs. 2.1%, p= 0.001). The median follow-up was 15,9 (1,2-33,9) years. Graft and recipient survival at 1, 3, 5, 10, and 20 years were similar between the groups (p=0.298). After matching for recipient age, donor sex, and transplant indication, the incidence of bilioma was comparable. Independent factors significantly affecting survival were recipient age (HR = 1.027, p=0.009), donor age (HR = 1.012, p=0.014), and duration of cold ischemia (HR = 1.002, p=0.018).

Conclusion: The very long-term follow-up of this study reinforces the safety and efficacy of RHL transplantation, demonstrating the role in expanding the donor pool without compromising very long-term outcomes.