Lifesaving re-transplantation with liver paired exchange donor

Liver re-transplantations (re-LTx) have been documented as high-risk operations considering technical and immunological challenges. However, improvements over the last two decades have increased success rates, bringing them closer to those of primary liver transplantations (LTx). At present, deceased organ shortage is a critical issue, and even potential live donors may not be suitable regarding vascular and biliary challenges, volume discrepancies, and ABO incompatibility for both primary and re-LTx. The hospital records of a patient who underwent two liver transplantations in our institution were evaluated retrospectively. A twelve-year-old girl with Progressive Familial Intrahepatic Cholestasis Type 3 underwent live-donor LTx with a graft from her mother. The patient required emergency re-LTx due to primary non-function of the graft, and there were no suitable deceased or live donors during that critical period. The patient was introduced to the liver paired exchange system and underwent a lifesaving re-LTx from an altruistic paired exchange donor. As a developing strategy, liver paired exchange transplantation is a reasonable solution to achieve the most suitable liver graft when it is most needed, especially in populations with very low deceased organ donation rates. There is a need for large studies to analyze the role and success of liver paired exchange transplantation in pediatric patients in urgent and elective situations.