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This study introduces two\u2010stage portal vein ligation and reperfusion for graft procurement in LDLT (PVLR\u2010LT), which aims to expand the left lateral lobe for achieving adequate grafts, thereby circumventing technical and anatomical limitations of conventional approaches. In a rat model, the PVLR\u2010LT group underwent selective portal vein ligation (step I) to induce targeted hypertrophy, followed by reperfusion and transplantation (step II). Outcomes were compared among PVLR\u2010LT, negative controls, and standard\u2010volume controls. Staged portal flow modulation effectively redistributed hepatic mass allocation, yielding grafts with graft recipient weight ratio approximately double that of negative controls and equivalent to standard\u2010volume controls. Donors experienced no mortality, with only transient enzyme elevation. Recipient survival in the PVLR\u2010LT group significantly exceeded that of the negative control group and was non\u2010inferior to that of the standard\u2010volume control group, while hepatic enzyme peaks were markedly lower than those in standard\u2010volume control recipients. This study provides a promising proof of concept, establishing the feasibility of using PVLR\u2010LT to convert the surgically straightforward left lateral segment into right lobe\u2010sized grafts through staged portal flow modulation and demonstrating the translational potential for laparoscopic LDLT.<\/jats:p>","DOI":"10.1002\/ame2.70121","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T08:00:10Z","timestamp":1767859210000},"page":"2288-2297","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two\u2010stage portal flow modulation for volume\u2010augmented grafts in living donor liver transplantation: Rat model validation"],"prefix":"10.1002","volume":"8","author":[{"given":"Yuqi","family":"Gong","sequence":"first","affiliation":[{"name":"The Fourth School of Clinical Medicine Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutong","family":"Chen","sequence":"additional","affiliation":[{"name":"The Fourth School of Clinical Medicine Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhoucheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Libin","family":"Dong","sequence":"additional","affiliation":[{"name":"Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengxing","family":"Lian","sequence":"additional","affiliation":[{"name":"Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province Hangzhou First People's Hospital  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Wang","sequence":"additional","affiliation":[{"name":"General Surgery, Cancer Center, Department of Hepatobiliary &amp; 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