First Dual-Graft Living Donor Liver Transplantation in Uzbekistan: Surgical Technique, Clinical Processes, And Preliminary Results.

Insufficient graft volume remains a major limitation in adult living donor liver transplantation, particularly in recipients with high body weight or advanced liver disease, increasing the risk of small-for-size syndrome and early graft dysfunction. Dual-graft living donor liver transplantation has emerged as a strategy to overcome graft size limitations in selected high-risk recipients. We report the first case of dual-graft living donor liver transplantation performed in Uzbekistan in a high-risk adult recipient with end-stage liver disease. Two partial liver grafts obtained from separate living donors were implanted using individualized vascular inflow, outflow, and biliary reconstruction techniques. Perioperative management and postoperative monitoring were conducted according to standard transplantation protocols. The combined graft volume provided an adequate graft-to-recipient weight ratio. Postoperative Doppler ultrasonography demonstrated satisfactory vascular inflow and outflow, with no evidence of thrombosis or venous congestion. Early postoperative laboratory evaluation revealed transient elevations of aminotransferases, followed by progressive improvement in bilirubin levels and markers of synthetic liver function. No early biliary complications, ascites, or need for reintervention was observed. At the 8-month follow-up, the recipient demonstrated normal liver function, preserved graft perfusion, and no vascular or biliary complications, while both living donors had uneventful postoperative recovery without donor-related complications. This national experience suggests that dual-graft living donor liver transplantation is a feasible and effective option for carefully selected high-risk adult recipients when performed in a specialized transplant center.