*Purpose: In the US, paired exchanges are common for LD kidney transplant but not for LDLT. We present our series of paired exchanges for LDLT, all done at a single large volume US LDLT program.

*Methods: Data was collected on all donors and recipients that underwent paired exchange LDLTs at our center.

*Results: A total of 8 paired exchanges (16 total transplants) were completed over the last 2 years. Of these, 3 involved ABO incompatible pairs with matched related donors for each recipient. The other 5 involved a non-directed donor, which was then used to initiate the paired exchange with an ABO incompatible donor/recipient pair. In all cases, the non-directed donor was blood type O. The 2^nd recipient in these cases was chosen from the deceased donor list based on factors such as MELD/PELD, size match, and anatomic suitability. Living donor advocacy and psychosocial evaluation were done as in standard LDLT. Both transplants were performed within 1 week of each other. All 16 donors are well with no major complications. Of the 16 recipients, 15 were adults and 1 was pediatric. 15 recipients are alive and well with good graft function. One recipient died in the early postoperative period.

*Conclusions: Paired exchange is technically feasible in a large volume LDLT center and can be a useful way to perform transplants in incompatible pairs. Use of a non-directed donor to initiate the exchange is a good option.

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