"Left at right" adult liver transplantation: The feasibility of heterotopic implantation of left liver graft

K. M. Chan, F. Z. Eldeen, C. F. Lee, T. J. Wu, H. S. Chou, T. H. Wu, R. S. Soong, W. C. Lee

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


Left liver grafts have been widely utilized in adult liver transplantation (LT) and yielded acceptable results. However, the conventional orthotopic implantation of a left liver graft imposes the potential risk of perioperative vascular complications. We report herein an alternative modified technique for adult left liver LT and evaluate its feasibility in LT. In this study, 10 recipients had their left liver graft rotated 180°, and heterotopically implanted at the right subphrenic space, which we termed "left at right" liver transplantation (LAR-LT). The sequence of vascular and biliary reconstruction was performed as standard techniques, and no perioperative vascular complications related to LAR-LT were encountered. There were two mortalities in this series, one due to a small-for-size graft dysfunction and the other due to postoperative internal hemorrhage. Two recipients had biliary strictures that were successfully managed by percutaneous biliary dilatation and Roux-en-Y hepaticojejunostomy. The clinical characteristics and outcomes of patients undergoing LAR-LT were also compared with patients undergoing conventional orthotopic left liver LT (n = 14). Although the results showed no significant difference between the two groups, according to our experience, the satisfactory outcome and easier technical reconstruction suggest that the LAR-LT modification could be a feasible alternative to left liver LT. The authors demonstrate that heterotopic implantation of a 180° rotated left liver graft in the right subphrenic space and a modified technique for vascular anastomosis can serve as a feasible technical alternative in left liver transplantation.

Original languageEnglish
Pages (from-to)1511-1518
Number of pages8
JournalAmerican Journal of Transplantation
Issue number6
Publication statusPublished - Jun 2012
Externally publishedYes


  • heterotopic implantation
  • left at right liver transplantation
  • left liver graft
  • liver transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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