ABO incompatible living donor liver transplantation using dual grafts and pure laparoscopic donor right hepatectomy: A case report

Rationale: Because of the shortage of deceased donors, living donor liver transplantation (LDLT) has become the main procedure to treat patients with end-stage liver disease in Asian countries. However, many potential donors are excluded because of donor safety and graft volume issues. In addition, large abdominal wounds after open surgery for hepatectomy could be a reason for hesitating to agree to liver donation, particularly when attempting to recruit young female donors. Patient concerns: On volumetric computed tomography (CT) examination, remnant liver volume was too small to guarantee the safety of the male donor, and the right hemiliver volume of the female donor was not sufficient to meet the recipient's metabolic demand. The young female donor also worried about a large abdominal wound following open surgery. Interventions: We performed ABO-incompatible LDLT using dual grafts and right-sided graft was obtained by pure laparoscopic donor right hepatectomy in a young female donor. Outcomes: The postoperative course was uneventful in both donors and the recipient is presently doing well in satisfactory condition 7 months after liver transplantation. Lessons: We overcame these volumetric and cosmetic issues through dual living donor liver grafts using a combination of conventional surgery for 1 donor and laparoscopic right hepatectomy for a second ABO-incompatible donor. We think this procedure can be a good option for the expansion of donor pools.