DUAL LOBE LIVER
TRANSPLANTATION

Two livers harvested from two donors
saved the life of one

It is a known fact that 50% of the standard liver volume of the recipient is the minimum liver graft volume required to provide adequate functional hepatocytes. To fulfill the metabolic demands of an adult recipient right liver lobe grafts with 60-70% of total liver mass are used for partial Orthotopic Liver Transplantation. The remnant liver volume should not be less than 30% of the total liver volume of the donor to maintain the donor's safety. Even though a donor’s right lobe is suitable in size as a graft for an adult recipient, the remaining left lobe may be too small when considering the safety of the donor. Under these circumstances, the donor cannot be allowed to either donate the right or left liver lobe for an adult recipient. In these rare scenarios, a second donor is required to perform Dual Graft Liver Transplantation in which one graft from each of two donors is implanted into one recipient. This alternative offers a sufficient graft size for the adult recipient as well as a higher degree of safety for the donors.

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This article reports the case of an adultto-adult Living Donor Liver Transplant (LDLT) performed on a patient using one left and one right lobe graft from two donors.
A patient was admitted with end-stage Liver Cirrhosis (Child-Pugh C-11/15) due to chronic hepatitis B/D infection with

MELD of 28. He was evaluated for Liver Transplant and was found fit to undergo a transplant. His two brothers were selected as potential donors. Volumetric computed tomography analysis of Donor 1 liver showed a right lobe GRWR of only 0.57 with a prospective remnant liver volume of 44% of his total liver volume. His left lobe GRWR was 0.46, with 55% remnant. The Donor 2 liver showed a right lobe GRWR of only 0.57 prospective remnant liver volume of 32% of his total liver volume. His left lobe GRWR was 0.27, with 67% remnant. So, neither of the two probable donors was suitable as a single donor, and the decision was made to perform LDLT using dual grafts. For this case, the doctors planned to harvest the right liver lobe of Donor 1 with respect to the prospective remnant liver volume of 44 % of his total liver volume, together with the left lobe of Donor 2 to receive an adequate total graft GRWR.

The operative procedure was uneventful. After five days in the intensive care unit (ICU), the patient was moved to the regular ward and was discharged on the 18th post-operative day with excellent graft function. The post-operative course of the donors was uneventful as well. Both the donors were kept in the ICU for a day and were discharged on postoperative day 7. So far, the patient and grafts are in satisfactory conditions. None of the donors, in either case, suffered from any complication related to the operative procedure.

Whereas, considering the normal course, there was a high likelihood that both donors could have been rejected. This case illustrates the successful orchestration of meticulous planning and technically challenging procedure wherein, both donors donated a part of their livers to save the life of a recipient.

 

Dr. Neeraj Bhalla

Dr. Abhideep Chaudhary
Director & HOD
HPB Surgery & Liver
Transplantation
BLK Centre for Digestive
& Liver Diseases
BLK Super Speciality
Hospital, New Delhi

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