The first two cases of living donor liver transplantation using dual grafts in Saudi Arabia

Expanding the Donor Pool to the Ultimate Level: Introducing the Revolutionary Hybrid Dual Graft Liver Transplant Using Domino and Living Donors

Background

Innovative solutions are crucial as the demand for liver transplants continues to outpace available grafts. Dual graft liver transplantation offers a promising avenue to address graft volume challenges while minimizing donor risks. This report introduces a groundbreaking approach, combining a full organ domino donor graft with a living donor graft for a hybrid dual graft liver transplant.

Brief Report

A 2-y-old child with Maple syrup urine disease and a 40-y-old adult with end-stage liver disease became the focus of this unique case. A hybrid dual graft liver transplant was executed, uniting the domino donor's full organ graft with a living donor's left lateral segment. Precise vascular and biliary reconstructions facilitated a successful transplant.

Conclusions

The hybrid dual graft liver transplant, merging domino donor and living donor grafts, presents a viable strategy to combat graft shortages, particularly in regions predominantly reliant on living donor transplants. Despite challenges, this pioneering approach should be embraced by established liver transplant centers because it enables concurrent living donor liver transplantation while prioritizing donor safety and recipient outcomes.

Groundbreaking Dual-Graft Living Donor Liver Transplant Utilizing Full Right and Left Lateral Lobe Grafts: A Landmark Debut in the Kingdom of Saudi Arabia

We introduce and documentthe first case of dual-graft living donor liver transplant, at the King Fahad Specialist Hospital in Dammam, Kingdom of Saudi Arabia, in which both a full right lobe and a left lateral segment graft were used. Our patient, a 63-year-old male, was diagnosed with nonalcoholic steatohepatitis cirrhosis and hepatocellular carcinoma involving segment 7 and selected for living donor liver transplant. Donor selection, graft volume assessment, surgical planning, procurement, and implantation of the dual grafts were meticulously executed. The first donor had an estimated right lobe volume of 639 mL, yielding an estimated graft-to-recipient weight ratio of 0.68. A liver biopsy revealed 3% macrosteatosis.The second donor's contribution comprised a left lateral segment volume of 280 mL.The decision was made for dual-graft liver transplant. With both grafts, the volume totaled 919 mL, representing graft-torecipient weight ratio of 0.98. Surgical techniques involved anastomoses of hepatic veins, portal veins, arteries, and biliary reconstruction. Both donors and the recipient were closely monitored posttransplant. After the procedure, both donors recovered swiftly and were discharged 4 days postoperation. The recipient experienced a smooth postoperative course, spending 4 days in the intensive care unit and discharged on day 26 posttransplant. This pioneering dual-graft living donor liver transplant showed successful outcomes and highlighted the potential of this approach to expand the limited donor pool, particularly in regions relying predominantly on living donors, like Saudi Arabia. This innovative surgical technique offers a promising solution to address the growing demand for liver transplants while ensuring safety for individual donors and maintaining acceptable recipient outcomes. Further exploration and adoption of dual-graft liver transplant could significantly affectthe field of livertransplant globally.