title: Dual-graft Adult Living Donor Liver Transplantation: An Innovative Surgical Procedure for Live Liver Donor Pool Expansion.
abstract: To detail the surgical technique and outcomes of dual-graft (DG) adult living donor liver transplantation (ALDLT).
  
  
  
  DG ALDLT has a great potential for expanding the living donor pool without increasing donor risk. However, little is known about DG ALDLT because it has been performed by a limited number of institutions due to its technical complexity.
  
  
  
  The clinical data of patients who underwent DG ALDLT at a single institute between March 2000 and December 2014 were retrospectively reviewed.
  
  
  
  In total, 400 DG ALDLTs, which accounted for 11.7% of all ALDLTs (n = 3387), were performed at our institute. The 1, 5, and 10-year patient survival rates of DG ALDLT were 89.2%, 85.5%, and 80.2%, respectively. In a propensity-matched cohort, there were no significant differences in the survival outcomes between DG and single-graft ALDLT (P = 0.163). Donor age, body mass index, and steatosis were significantly higher in the DG group. Additionally, the male predominance in the sex ratio of donors was lower in the DG group. In the DG group, the mean operative time was longer (18.7 vs 13.9 h; P < 0.001) and there was greater requirement for intraoperative transfusion of red blood cells (18.2 vs 11.4 units; P < 0.001). Additionally, the surgical complication rate per patient was significantly higher (53.7 vs 28.5%; P < 0.001).
  
  
  
  DG ALDLT enables us to achieve an acceptable survival outcome with 2 suboptimal grafts. However, technical complexity and longer operative time limit is its drawback.
authors.affiliation: Division of Liver Transplantation and Hepato-Biliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Ki-Hum
authors.initials: KH
authors.lastname: Kim
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate