Advances in Transplant

As the United States continues to face a major organ shortage, liver experts consider innovative methods to increase the number of liver allografts. Living donor liver transplants have been instrumental in expanding the donor pool, but a liver paired exchange program could expand the pool even further for patients with ABO incompatible and size mismatched living donors.

Guidance From Kidney Paired Exchange

Based on the success of kidney paired exchange programs in the United States, many liver transplant experts are looking to these programs for guidance (Mishra A, Lo A, Lee GS, Samstein B, Yoo PS, Levine MH, Goldberg DS, Shaked A, Olthoff KM, Abt PL. Liver paired exchange: Can the liver emulate the kidney? Liver Transpl. 2018;24:677-686). Although many aspects of the paired exchange are similar, there is a increased complexity in donor hepatectomy and living donor liver transplant which investigators are taking into consideration when designing trials. To date, there have been only a handful of liver paired exchange single-center experiences in the United States.

UNOS Phase I Study

In collaboration with the United Network for Organ Sharing, plans are underway to conduct a nationwide Phase I pilot study to examine the safety and feasibility of a living donor liver paired exchange program. As a principal investigator of the study, Benjamin Samstein, MD, Surgical Director, Living Donor Liver Transplant Program, NewYork-Presbyterian/Weill Cornell to, is helping to develop appropriate criteria for patient and medical center participation. A registry and coordinating center for liver paired exchange pairs.

Priority will be placed on high-volume, UNOS-designated living donation transplant centers. In order to be designated as a living donor center, UNOS mandates that the program meet certain requirements regarding the facility and the expertise of physicians and surgeons involved, including a focus on training and experience in living donor organ recovery and post-transplant care of living donors.

The NewYork-Presbyterian Experience

Because we have enough experienced surgeons to perform paired exchanges, our patients have increased options to donate or receive a life-saving organ. To date, we have performed more than 400 living donor liver transplantations, including the highest number of laparoscopic left-lobe donations in North America.

In light of SARS-COV2, the Center for Liver Disease and Transplantation at NewYork-Presbyterian is taking special precautions. Currently, we are performing transplant procedures and providing non-emergency telemedicine visits. To refer a patient, please call your preferred campus. We are committed to sharing the lessons we’ve learned from the pandemic in order to provide optimal care for patients.