Living Donor Exchange Program for Adult Living Donor Liver Transplantation: Preliminary Experience at the Asan Medical Center, Korea

Lee, Hyo Jun; Hwang, Shin; Lee, Sung Gyu; Ahn, Chul Soo; Kim, Ki Hun; Moon, Deok Bog; Ha, Tae Yong; Song, Gi Won; Park, Kwang Min; Jung, Dong Hwan; Ryu, Je Ho; Park, Jeong Ik; Kim, Kwan Woo; Ko, Kyung Hoon; Choi, Nam Kyu

Abstract

PURPOSE: When performing donor screening for living donor liver transplantation (LDLT) for an adult patient with end- stage liver disease, ABO blood group incompatibility is the most common cause of donor exclusion. To cope with this problem without performing ABO-incompatible LDLT, living donor exchange program has been maintained at the Asan Medical Center, Seoul, Korea since September 2003. Here we introduce the clinical experience of 6 cases of adult LDLT allocated by living donor exchange program.
METHODS
From February, 1997 to December 2006. 1208 cases of adult LDLT were performed in our institution. Among them, there were 6 cases allocating through donor exchange program to avoid ABO blood group mismatching. Three sets of 2 donor-recipient combination pairs were made after direct one-to-one donor-recipient matching.
RESULTS
Two sets of donor exchange LDLT were performed on elective surgery basis, but one in emergency situation. Two living donors and 2 recipients underwent LDLT operations at the same time at the same institution. All 6 living donors recovered well. All of the 6 recipients are doing well to date although 1 recipient had undergone prolonged intensive care for surgical complications. There was no emotional or psychological conflict related to donor exchange program.
CONCLUSION
This is the world-first report on donor exchange adult LDLT. Although this is a preliminary report with only 3 sets, donor exchange program for adult LDLT appears to be a feasible modality to promote LDLT. We believe it can be applicable to a wider population of LDLT after widespread consensus formation.