Seventeen adult-to-adult living donor liver transplantations using dual grafts

Dual liver transplantation

“…According to the Fan et al (2000) criteria, the volume of remnant liver should exceed 30%, while Lee et al (2001b) believes that the volume of remnant liver should exceed 35% (Kawasaki et al, 1998). Previous study has shown, in Table 2 in the first seven cases, average GRWR and GV/SLV to be 1.06% and 58.1%, respectively, with good results, but from Cases 8 to 25, GV/SLV ranges from 46.6% to 78.9% with three patients dying (Lee et al, 2001b).…”

“…Firstly, is the donor's left liver lobe too small to meet the metabolic demand of the recipient (Lee et al, 2001b)? Secondly, is the proportion of the donor's right lobe to the left lobe unusually high (greater than 70% of total liver volume) (Lee et al, 2001b), so that right lobectomy in the donor would lead to a high risk of liver insufficiency in the immediate postoperative period? Thirdly, the total volume of the dual graft should be at least 50% of the standard liver volume of the recipient, and the remaining liver in the donor should be more than 35% of the standard liver volume of the donor.…”

“…The initial series of dual liver transplantations was reported by Lee et al (2001b). According to their report, 94% (16/17) of patients received a dual left lobe or one left and one lateral segment graft, and only 6% (1/17) received one left and one right lobe graft.…”

“…For the graft of two left lobes or one left lobe and left lateral lobe, the differences are as follows (Lee et al, 2001b). (1) The second liver graft need to be rotated 180° and heterotopically positioned to the right upper quadrant after the first liver graft is orthotopically implanted at the original left position.…”

“…With the objective of achieving maximal donor safety by minimizing the mass of resected liver, the technique of "dual liver" adult-to-adult LDLT has been introduced, in which two lobe grafts are removed from two donors and grafted into one recipient (Lee et al, 2001a;Lee et al, 2001b;Kaihara et al, 2002;Wang et al, 2006;Broering et al, 2007). Lee et al (2001a) first proposed the concept of dual left lobe grafts for liver transplantation and performed the first in 2001.…”