Living donor liver transplantation using dual grafts: Experience and lessons learned from cases worldwide.
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 involving a second living donor need to be addressed. In conclusion, dual graft LDLT should be prudently performed in select cases by surgeons of proven expertise when single donation is unacceptable and a second living donor is available. The decision-making criteria need to be standardized. More surgical modification and clinical research are needed.
Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China.|Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Yinzhe
Y
Xu
Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China.
Hao
H
Chen
Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Heidi
H
Yeh
Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China.
Hongguang
H
Wang
Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China.
Jianjun
J
Leng
Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Haidian, Beijing, China.|Beijing Tsinghua Changgung Hospital, Tsinghua University Medical Center, Changping, Beijing, China.
Jiahong
J
Dong
D014943:Global Health; D006801:Humans; D015994:Incidence; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends