Introduction Blood transfusion is often necessary in patients undergoing liver resection. Because of the risks associated with allogeneic blood products, pre-operative autologous blood donation has been advocated, but its benefit is unclear. This study compares peri-operative outcome in patients transfused only with autologous blood to a matched cohort transfused with allogeneic blood. Methods All patients subjected to hepatic resection and given peri-operative autologous red cell transfusions (Auto) were identified from a database of 2123 patients and reviewed retrospectively. This group was matched to patients transfused with a comparable number of allogeneic red cell units (Allo) and to a control group that received no blood products. All patients in the Auto or Allo group received either 1 or 2 units. Matching was based on age, comorbidity, extent of hepatic resection, and estimated blood loss. Matched pair analysis was performed using the t-test and McNemar’s test. Results From 12/91 to 5/03, 124 patients undergoing hepatic resection received peri-operative autologous blood only, for which optimal matching was possible in 104. The groups were similar with respect to age, co-morbidities, and blood loss; the proportions receiving pre-operative chemotherapy, requiring a major resection (≧ 3 segments) or a complex procedure (concomitant major procedure in addition to the principal hepatic resection) were also similar. There were no differences between the Allo and Auto groups in length of hospitalization, complications, and operative mortality. Conclusions In patients undergoing hepatic resection, autologous blood transfusion does not demonstrably improve peri-operative outcome when compared to a matched cohort of patients receiving a similar number of allogeneic units.