Section 16. Update on experience in paired-exchange donors in living donor liver transplantation for adult patients at ASAN Medical Center.
BACKGROUND
An exchange living donor program for liver transplantation, similar to the exchange living donor kidney program, was proposed to avoid ABO-incompatible adult living donor liver transplantation (LDLT). The objective of this study was to present updated changes in exchange adult LDLT program at our institution.


METHODS
Between January 2003 and December 2011, approximately 2,182 adult LDLT cases were included in this study. During this period, 26 paired-exchange donor LDLT cases were performed (1.2%).


RESULTS
Of the 26 paired-exchange donor LDLT cases, 22 pairs were matched due to ABO-incompatibility, and 4 pairs were matched because of cascade allocation of unrelated donors or relatively small graft volume to the recipients. A total of 28 living donors were included in the 26 paired-exchange donor LDLT cases because of inclusion of two dual-graft transplants. Elective surgery was performed in 22 cases, and urgent operation was performed in 4 cases. The overall 1-year and 5-year patient and graft survivals were both 96.2% and 90.1%, respectively.


CONCLUSIONS
Our experience suggests that the paired-exchange donor program for adult LDLT seems to be a feasible modality to overcome donor ABO incompatibility. Reasonably acceptable indications for donor exchange LDLT will be proposed in near future.
1 Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 2 Address correspondence to: Sung-Gyu Lee, M.D., Ph.D., F.A.C.S., Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea.
Dong-Hwan
DH
Jung
Shin
S
Hwang
Chul-Soo
CS
Ahn
Ki-Hun
KH
Kim
Deok-Bog
DB
Moon
Tae-Yong
TY
Ha
Gi-Won
GW
Song
Gil-Chun
GC
Park
Sung-Gyu
SG
Lee
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D056910:Republic of Korea; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000017:ABO Blood-Group System