• Gi-Won Song, Sung-Gyu Lee, Deok-Bog Moon, Chul-Soo Ahn, Shin Hwang, Ki-Hum Kim, Tae-Yong Ha, and Dong-Hwan Jung.
• Division of Liver Transplantation and Hepato-Biliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
• Ann. Surg. 2017 Jul 1; 266 (1): 10-18.

ObjectiveTo detail the surgical technique and outcomes of dual-graft (DG) adult living donor liver transplantation (ALDLT).BackgroundDG ALDLT has a great potential for expanding the living donor pool without increasing donor risk. However, little is known about DG ALDLT because it has been performed by a limited number of institutions due to its technical complexity.MethodsThe clinical data of patients who underwent DG ALDLT at a single institute between March 2000 and December 2014 were retrospectively reviewed.ResultsIn total, 400 DG ALDLTs, which accounted for 11.7% of all ALDLTs (n = 3387), were performed at our institute. The 1, 5, and 10-year patient survival rates of DG ALDLT were 89.2%, 85.5%, and 80.2%, respectively. In a propensity-matched cohort, there were no significant differences in the survival outcomes between DG and single-graft ALDLT (P = 0.163). Donor age, body mass index, and steatosis were significantly higher in the DG group. Additionally, the male predominance in the sex ratio of donors was lower in the DG group. In the DG group, the mean operative time was longer (18.7 vs 13.9 h; P < 0.001) and there was greater requirement for intraoperative transfusion of red blood cells (18.2 vs 11.4 units; P < 0.001). Additionally, the surgical complication rate per patient was significantly higher (53.7 vs 28.5%; P < 0.001).ConclusionsDG ALDLT enables us to achieve an acceptable survival outcome with 2 suboptimal grafts. However, technical complexity and longer operative time limit is its drawback.

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