Split Liver Transplantation Using Hemiliver Graft for 2 Adults: A Case Study

Using donor organs efficiently to help the most patients

By Koji Hashimoto, MD, PhD

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As one of the solutions for severe donor shortage in liver transplantation, Cleveland Clinic performed two liver transplants simultaneously from one deceased donor by splitting a liver graft into two hemiliver grafts. 

This highly complex procedure requires an experienced surgical team with expertise in both transplant surgery and hepatobiliary surgery. Because splitting a whole liver graft creates two smaller partial grafts, the risk of liver transplant failure is generally considered to be higher than liver transplantation using a whole liver graft. As a result, this procedure remains underutilized.  


The patients are a 65-year-old female with primary biliary cirrhosis and a 54-year-old male with hepatitis C-related cirrhosis and hepatocellular carcinoma. Both were listed for liver transplantation at Cleveland Clinic. A brain-dead donor became available and the decision was made to proceed with split-liver transplantation. Our donor team split the whole liver in situ before the liver was procured from the donor. The split liver grafts were brought back to Cleveland Clinic’s main campus to be simultaneously transplanted into the two recipients.  Despite complex vascular and biliary anastomoses, both recipients did very well with excellent liver graft function. The patients were discharged from hospital in six and nine days, respectively.

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  1. Hashimoto K, Quintini C, Aucejo FN, Fujiki M, Diago T, Watson MJ, Kelly DM, Winans CG, Eghtesad B, Fung JJ, Miller CM. Split liver transplantation using hemiliver graft in the MELD era: a single center experience in the United States. Am J Transplant 2014;14:2072-2080.
  2. Hashimoto K, Fujiki M, Quintini C, Aucejo FN, Uso TD, Kelly DM, Eghtesad B, Fung JJ, Miller CM. Split liver transplantation in adults. World J Gastroenterol 2016;22:7500-7506.