Expanding Living Donor Liver Transplantation

Report of First US Living Donor Liver Transplant Chain

Hillary J. Braun; Ana M. Torres; Finesse Louie; Sandra D. Weinberg; Sang-Mo Kang; Nancy L. Ascher; John P. Roberts


American Journal of Transplantation. 2021;21(4):1633-1636. 

In This Article

Abstract and Introduction


Living donor liver transplantation (LDLT) enjoys widespread use in Asia, but remains limited to a handful of centers in North America and comprises only 5% of liver transplants performed in the United States. In contrast, living donor kidney transplantation is used frequently in the United States, and has evolved to commonly include paired exchanges, particularly for ABO-incompatible pairs. Liver paired exchange (LPE) has been utilized in Asia, and was recently reported in Canada; here we report the first LPE performed in the United States, and the first LPE to be performed on consecutive days. The LPE performed at our institution was initiated by a nondirected donor who enabled the exchange for an ABO-incompatible pair, and the final recipient was selected from our deceased donor waitlist. The exchange was performed over the course of 2 consecutive days, and relied on the use and compliance of a bridge donor. Here, we show that LPE is feasible at centers with significant LDLT experience and affords an opportunity to expand LDLT in cases of ABO incompatibility or when nondirected donors arise. To our knowledge, this represents the first exchange of its kind in the United States.


Living donor liver transplantation (LDLT) remains the primary method of liver transplantation in Asia but continues to comprise <5% of liver transplants performed annually in the United States.[1] As of 2019, only 10 United States transplant centers performed more than 10 LDLT per year.[2]

Our center is located in Region 5, and our median model for end-stage liver disease (MELD) score at transplant is 32. Over the past 5 years, we have performed an average of 27 adult to adult LDLT per year in an effort to expand LDLT and enable transplantation in liver waitlist candidates who have a living donor and may otherwise spend a significant amount of time on the waitlist. In 2017, we performed a sentinel living donor liver-kidney exchange.[3] Here, we report our experience with a LDLT chain. Liver paired exchange (LPE) has been reported in Asia[4] and Canada;[5] this represents the first report of its kind in the United States.