Dual graftを用いた生体肝移植

抄録

Liver transplantation is the standard therapy for end-stage liver disease, yet the persistent shortage of suitable donors remains a significant barrier. In response, various surgical innovations have been developed, including living donor liver transplantation (LDLT), particularly in Asia where social and cultural factors limit deceased donation. When a single living donor is unsuitable due to insufficient graft volume or hepatic steatosis, dual graft liver transplantation (DGLT) offers a viable alternative by utilizing two partial grafts from separate donors. Our institution initiated a dual graft living donor liver transplantation (DGLDLT) program in 2023. To date, we have performed three successful cases using two left-lobe grafts to prioritize donor safety. These experiences demonstrate that DGLT can be a feasible and effective approach, allowing the use of otherwise unsuitable donors while maintaining graft viability. Between 2013 and 2023, 144 patients were evaluated as suitable candidates for LDLT at our center, but 52 (36%) could not undergo transplantation due to donor limitations—mainly insufficient liver volume or fatty liver. This highlights the critical role of DGLT in expanding transplant eligibility in regions facing donor shortages. While DGLT requires meticulous planning and carries ethical considerations due to the involvement of two donors, our initial results support its utility and safety. Continued refinement and experience will be essential to further establish DGLT as a reliable option in living donor liver transplantation.