Liver paired exchange: Can the liver emulate the kidney?

Abstract

Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE. Liver Transplantation 24 677-686 2018 AASLD.

Whose Liver Is It Anyway? Two Centers Participating in One Living Donor Transplantation

“…(2) However, LDLT constitutes only 4% of liver transplants in the United States, revealing the significant potential for increased growth in living donation. (3) Liver paired exchange (LPE) is an innovative method to increase the donor pool and the probability of meeting the prerequisites of LDLT, such as ABO compatibility and safe donor anatomy. (2) As an initial step, LPE would have to begin with 2-way swaps, which are the simplest form of exchange.…”

“…(2) As an initial step, LPE would have to begin with 2-way swaps, which are the simplest form of exchange. (3) For this to succeed and for LPE to eventually gain widespread acceptance in the United States, many obstacles must be overcome, including addressing the issue of equality and simultaneity. (2,3) Many of these obstacles may be obviated if the swaps are performed at the same center, which allows for more control over logistical issues and intraoperative planning but requires increased resource utilization.…”

“…(3) For this to succeed and for LPE to eventually gain widespread acceptance in the United States, many obstacles must be overcome, including addressing the issue of equality and simultaneity. (2,3) Many of these obstacles may be obviated if the swaps are performed at the same center, which allows for more control over logistical issues and intraoperative planning but requires increased resource utilization. (3) However, there are few centers that actively perform LDLT in the United States and even fewer that are able to perform 2 LDLT procedures at a single institution simultaneously.…”

“…(2,3) Many of these obstacles may be obviated if the swaps are performed at the same center, which allows for more control over logistical issues and intraoperative planning but requires increased resource utilization. (3) However, there are few centers that actively perform LDLT in the United States and even fewer that are able to perform 2 LDLT procedures at a single institution simultaneously. (3) Therefore, the initial stage of an LPE program would have to involve 2 experienced centers with geographical proximity.…”

“…(3) However, there are few centers that actively perform LDLT in the United States and even fewer that are able to perform 2 LDLT procedures at a single institution simultaneously. (3) Therefore, the initial stage of an LPE program would have to involve 2 experienced centers with geographical proximity. (3) Establishing an understanding between donor and recipient centers during pretransplant planning and intraoperative communication would be crucial.…”