DUAL-GRAFT LIVING DONOR LIVER TRANSPLANTATION: AN INNOVATIVE SURGICAL PROCEDURE FOR LIVE LIVER DONOR POOL EXPANSION

G. -W. Song, S. -G. Lee, C. -S. Ahn, D. -B. Moon, S. Hwang, K. -H. Kim, T. -Y. Ha, D. -H. Jung, G. -C. Park and M. J. Jeong Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea Introduction: To detail the surgical technique and outcomes of dual-graft (DG) adult living donor liver transplantation (ALDLT). Background: 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. Methods: The clinical data of patients who underwent DG ALDLT at a single institute between March 2000 and December 2014 were retrospectively reviewed. Results: 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%, 84.0%, and 80.2%, respectively, which were not statistically different from those of singlegraft ALDLT (P = 0.060). In a propensity-matched cohort, there were no significant differences in the survival outcomes. Donor age, body mass index, and steatosis were significantly higher in the DG group. Additionally, the male predominance in the gender ratio of donors was lower in the DG group. In the DG group, the mean operative time was longer (18.7 vs 13.9 hours, 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 (28.5% vs 53.7%, P< 0.001). Conclusions: DG ALDLT enables us to achieve an acceptable survival outcome with 2 suboptimal grafts. However, its technical complexity and longer operative time limit its widespread application.