Living donor liver transplantation using dual grafts: Experience and lessons learned from cases worldwide

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Yinzhe XuJiahong Dong

Abstract

In living donor liver transplantation (LDLT), insufficient graft volume could result in small-for-size syndrome in recipients, whereas major liver donation predisposes the donor to a high risk of posthepatectomy liver failure. Dual graft LDLT is therefore introduced to obtain combined graft sufficiency. To date, 367 patients have been reported worldwide. We reviewed all the relevant literature, with a special focus on 43 case reports containing enough data to extract and analyze. A simple decision-making algorithm was developed. Dual graft LDLT is indicated when (1) a single donation is unacceptable due to graft-to-recipient size mismatch; (2) the future liver remnant is insufficient in the single donor after major resection; or (3) there is a significant underlying disorder or anatomical variation within the donor liver. The outcome of dual graft LDLT is reported to be comparable with that of single donor LDLT. Unilateral graft atrophy was found in 7 of the 43 patients, predominantly in the right-sided, heterotopic and initially smaller grafts. Technically, the heterotopic implantation and complex vascular reconstruction are the most demanding. Elaborate surgical planning and modification are needed. Ethical concerns about inv...Continue Reading

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Citations

Oct 13, 2016·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Shaleen AgarwalSubash Gupta
Dec 13, 2016·Transplantation·Geraldine C DiazJohn F Renz
Aug 2, 2017·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·J H KwonS G Lee
Jun 23, 2018·World Journal of Gastroenterology : WJG·Xiang LanBo Li
Oct 24, 2019·BMC Surgery·Nikam VinayakShrimal Anurag
Apr 3, 2021·Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation·Zhen WanYi Lv

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