Primeiro transplante duplo de fígado esquerdo intervivos adultos do Brasil

Nicoluzzi, João Eduardo Leal; Silveira, Fábio; Macri, Matheus Martin; Monteiro, Mauro; Woitovicz, Vinícius; Stalchimidt, Fábio

doi:10.1590/s0100-69912012000300012

Cited by 5 publications

References 13 publications

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

Chen

Yeh

et al. 2015

Liver Transpl

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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. Liver transplantation (LT) is now a gold standard treatment for patients with end-stage or irreversible liver disease, which may restore liver function and yield optimal oncologic outcome as well. The shortage of organ donors, however, has long been the main obstacle in LT activities. Various surgical strategies have been adopted to address the increasing donor-recipient disproportion, including cadaveric split liver transplantation (SLT),

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