Aim: Organ shortage becomes the most critical issue when an emergency liver transplantation is required. Paired exchange liver transplantation (LPE LDLT) is a developing strategy to eliminate the barriers to achieve the most suitable living liver allograft in pediatric population especially in the countries with very low deceased organ donation rates. In this study we aimed to analyze our patients who underwent lifesaving urgent LPE LDLT.

Method: The medical records of the pediatric patients who had LDLT with paired exchange donors were evaluated retrospectively. We further analyzed the patients who received LPE LDLT under emergency conditions in terms of transplant indications, LPE indications, recipient and graft characteristics, and clinical outcomes. 

Results: We performed 353 LPE transplants including 54 with recipients under 18 years old in our LPE LDLT Program. Pediatric patients were included in 2-way (n=16), 3-way (n=12), 4-way (n=9), 5-way (n=2), 6-way (n=12), and 7-way (n=3) exchanges. Median age and weight at time of transplantation were 7.7 years (range 0.4-17.9 years) and 20.5 kg (range 4.8-94 kg) respectively. Four patients were involved in emergency liver transplantations with acute hepatic necrosis (n=2), acute decompensation of Wilson’s Disease and primary non-function following living-related liver transplantation. All of the patients were listed before for emergency deceased donor nationwide and there was no organ available. Patients presented living-related donors, however ABO incompatibility (n=2) and disproportionate graft-residual volumes in addition to unfavorable vascular anatomy (n=2) resulted in listing their designated donors for LPE LDLT. All patients survived with no major surgical complications through timely performed liver transplants with paired exchange donations. 

Conclusions: LPE LDLT is a reasonable solution to achieve the most suitable living liver allograft when it is most needed as a lifesaving procedure for the benefit of the pediatric patients with good ethical practices.