20 Adult-to-Adult Living Donor Liver Transplantations Using Dual Grafts / 대한이식학회지

ABSTRACT

PURPOSE: The major limitation of adult-to-adult living donor liver transplantation (A-A LDLT) is the adequacy of the graft size. As an alternative, dual grafts from two living donors can solve the problem of graft-size insufficiency and guarantee the donor safety in many occasions. The present study aims to introduce the usefulness of dual-grafts A-A LDLT by review of our single center experience. METHODS: After the first successful pediatric LDLT in December 1994 and A-A LDLT in February 1997, 392 LDLTs including 73 pediatric and 319 adult cases were performed at Asan Medical Center until December 2001. Among 319 A-A LDLTs, 20 recipients implanted dual grafts were retrospectively analysed from March 2000 to December 2001. RESULTS: The ratio of graft volume to standard liver volume of the recipients ranged from 46.6% to 78.9%. More than 50% of the standard liver volume of the recipients was implanted in 16 patients. There was acute rejection episode in two patients, which were responded by pulsed steroid therapy. There were 3 in- hospital mortality (<3 month posttransplantation). CONCLUSION: In LDLT, the donor safety is the major concern. Although the donor has a large right lobe of liver that is adequate as a graft for large-size recipient, the remaining left lobe of liver is sometimes too small to endanger the donor safety. In this circumstance, the donor cannot be accepted to donate his or her right or left lobe of liver. Dual grafts from two living donors can help to alleviate the problem of small-for-size graft and secure the donor safety.