Saturday, November 5, 2022

Liver exchange--a review by Agrawal, Gupta and Saigal

 

 Here's a review of liver exchange in the transplant literature, with some comparisons to kidney exchange.

Paired exchange Living donor Liver Transplantation: Indications, stumbling blocks, and future considerations by Dhiraj Agrawal, Subhash Gupta,  and Sanjiv Saigal, Journal of Hepatology, In Press,  Pre-proof https://doi.org/10.1016/j.jhep.2022.10.019 

Abstract: "The last decade has seen Liver Paired exchange (LPE) as an increasingly used modality across the transplant community by which pairs of incompatible living Liver donors and their intended recipients swap Livers resulting in compatible transplants. The feasibility and benefit of LPE in providing excellent recipient outcomes and robust donor safety have been proven in uncomplicated swaps. Began initially as single-centre two-way or three-way exchanges, LPE has tremendous potential to grow into more complicated chains over days and over multiple centres. Also, LPE is associated with unique technical, logistical, ethical and legislative challenges. This review discusses the indications, potential types of LPE, unique solutions to stumbling blocks in performing LPE, and future considerations on how LPE can expand the living donor liver pool and the armamentarium of living donor liver transplantation (LDLT)".


"
The published literature on LPE has nine reports (5 original articles and 4 case reports), including 74 LPEs from Asia and North America.1), 2), 3), 4), 5), 6), 7), 8), 9) LPE constitutes approximately 1.2 to 8.3 % of the total LDLTs performed at the individual centre1), 2), 3), 4), signifying a substantial potential of this form of LDLT to mitigate the liver allograft shortage."

...

1. D. Agrawal, S. Saigal, S.S. Jadaun, S.A. Singh, S. Agrawal, S. Gupta
Paired Exchange Living Donor Liver Transplantation: A Nine-year Experience From North India
Transplantation (2022 Jun 30), 10.1097/TP.0000000000004210
Epub ahead of print. PMID: 35777310
2)
S. Hwang, S.G. Lee, D.B. Moon, G.W. Song, C.S. Ahn, K.H. Kim, et al.
Exchange living donor liver transplantation to overcome ABO incompatibility in adult patients
Liver Transpl, 16 (4) (2010 Apr), pp. 482-490, 10.1002/lt.22017
PMID: 20222052
3)
D.H. Jung, S. Hwang, C.S. Ahn, K.H. Kim, D.B. Moon, S.G. Lee, et al.
Section 16. Update on experience in paired-exchange donors in living donor liver transplantation for adult patients at ASAN Medical Center
Transplantation, 97 (Suppl 8) (2014 Apr 27), pp. S66-S69, 10.1097/01.tp.0000446280.81922.bb
PMID: 24849838
4)
V. Gunabushanam, S. Ganesh, K. Soltys, G. Mazariegos, A. Ganoza, M. Molinari, et al.
Increasing Living Donor Liver Transplantation Using Liver Paired Exchange
J Am Coll Surg, 234 (2) (2022 Feb 1), pp. 115-120, 10.1097/XCS.0000000000000036
PMID: 35213430
5)
A. Kaplan, R. Rosenblatt, W. Jackson, B. Samstein, R.S. Brown Jr.
Practices and Perceptions of Living Donor Liver Transplantation, Non-directed Donation, and Liver Paired Exchange: A National Survey
Liver Transpl, 28 (5) (2022 May), pp. 774-781, 10.1002/lt.26384
Epub 2021 Dec 26. PMID: 34862704; PMCID: PMC9018478
6)
H.J. Braun, A.M. Torres, F. Louie, S.D. Weinberg, S.M. Kang, N.L. Ascher, et al.
Expanding living donor liver transplantation: Report of first US living donor liver transplant chain
Am J Transplant, 21 (4) (2021 Apr), pp. 1633-1636, 10.1111/ajt.16396
Epub 2020 Dec 8. PMID: 33171017; PMCID: PMC8016700
7)
M.S. Patel, Z. Mohamed, A. Ghanekar, G. Sapisochin, I. McGilvray, N. Selzner, et al.
Living donor liver paired exchange: A North American first
Am J Transplant, 21 (1) (2021 Jan), pp. 400-404, 10.1111/ajt.16137
Epub 2020 Jul 10. PMID: 32524750
8)
S.C. Chan, C.M. Lo, B.H. Yong, W.J. Tsui, K.K. Ng, S.T. Fan
Paired donor interchange to avoid ABO-incompatible living donor liver transplantation
Liver Transpl, 16 (4) (2010 Apr), pp. 478-481, 10.1002/lt.21970
PMID: 20373459
9)
S.C. Chan, Chok KSh, W.W. Sharr, A.C. Chan, S.H. Tsang, W.C. Dai, et al.
Samaritan donor interchange in living donor liver transplantation
Hepatobiliary Pancreat Dis Int, 13 (1) (2014 Feb), pp. 105-109, 10.1016/s1499-3872(14)60016-3
PMID: 24463089

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