• Vikraman Gunabushanam, Swaytha Ganesh, Kyle Soltys, George Mazariegos, Armando Ganoza, Michele Molinari, Amit Tevar, Christopher Hughes, and Abhinav Humar.
• From the Division of Transplant Surgery (Gunabushanam, Ganoza, Molinari, Tevar, Hughes, Humar), University of Pittsburgh Medical Center, Pittsburgh, PA.
• J. Am. Coll. Surg. 2022 Feb 1; 234 (2): 115-120.

BackgroundLiving donor liver transplantation (LDLT) continues to be the primary modality of liver transplantation in Asia, but it accounts for about 5% of all liver transplantations in the US. ABO incompatibility is the primary reason motivated donors are declined. Although kidney paired exchanges are common, liver paired exchange (LPE) is still evolving in the US.Study DesignThis is a retrospective review (between January 1, 2019, and July 31, 2021) of our initial experience with LPE.ResultsA total of 10 LPEs (20 LDLTs) were performed during the study period. Seven LPEs were initiated by a nondirected O donor. The other 3 pair sets involved 1 ABO compatible and 1 ABO incompatible pair. Transplantations in a pair set were completed within a mean of 4.8 (range 1-14) days of each other. All 20 donors are doing well with no major complications at 12.7 (range 1-20) months. Seventeen of 20 recipients are alive and have good allograft function. One recipient died in the early postoperative period. Two late deaths of patients with functioning allografts were due to COVID-19 (at 8 months) and peritoneal carcinomatosis and gram-negative sepsis (at 9 months).ConclusionsLPE is feasible in a high-volume LDLT center and is a useful option to increase LDLT by overcoming ABO incompatibility. Nondirected donors can be utilized to initiate an LPE.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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