Living donor liver paired exchange between pediatric and adult recipients due to donor graft size mismatch

Living donor liver transplantation is an effective means to decrease organ shortage. However, many potential living donors are currently being denied due to ABO incompatibility or inadequate donor liver volume. Liver paired exchange (LPE) provides a practical solution to overcome these obstacles, and yet the first case of LPE in the United States was only recently reported in 2020. Here, we report world's first case of LPE involving pediatric and adult recipients to avoid surgical complexity of the pediatric recipient and to increase the graft-to-recipient weight ratio of the adult recipient between 2 ABO compatible pairs. As living donor liver transplantation becomes more widely adopted, the need for pair exchange to improve surgical safety and postoperative outcomes between 2 ABO compatible pairs is likely to increase.

Automated summary

Living donor liver transplantation is an effective solution to organ shortage, but ABO incompatibility or inadequate liver volume often prevents potential living donors from donating. Liver paired exchange (LPE) offers a practical solution to overcome these obstacles, and this study reports the world's first LPE case involving pediatric and adult recipients. This approach aims to avoid surgical complexity in the pediatric recipient and improve the graft-to-recipient weight ratio in the adult recipient of two ABO compatible pairs.