A dual-lobe strategy in living-donor liver transplantation: overcoming small-for-size graft limitations in an obese patient: a case report

The primary goal of living donor liver transplantation (LDLT) is to optimize outcomes for the recipient while ensuring donor safety. However, there is a risk of small-for-size syndrome, particularly in obese patients, where graft weight might be inadequate. In such scenarios, dual-lobe LDLT represents a more viable alternative. Although ethical concerns exist regarding potential risks posed to two healthy donors, this method may be most appropriate when deceased donor grafts are unavailable. Here, we describe a case involving an obese patient classified as Child-Pugh class C with chronic liver disease who underwent dual-lobe LDLT. The criteria for selecting the right lobe graft differed slightly from standard protocols, as did the implantation technique. The patient experienced low-output bile leakage, which resolved spontaneously. Priority in graft selection was given to the number of bile ducts, as the right lobes of both donors had nearly equal volumes. Despite simultaneous implantation, cold and warm ischemia times remained manageable due to effective coordination. Although the literature suggests a higher incidence of vascular and biliary complications in dual-lobe LDLT than in single-lobe procedures, these risks can be mitigated by careful planning and coordination.