Living donor liver transplantation in adults: Outcome in Japan

Abstract

T he evolution of liver transplantation in Japan has been quite different from its evolution in Western countries. Traditional religious, emotional, and historical issues have presented long-standing obstacles to cadaveric liver transplantation. The first brain death law was approved in Japan only 2 1 ⁄2 years ago, and only 7 cadaveric liver transplantations have been performed to date. In the past, the difficulty of performing cadaveric liver transplantation in Japan forced many patients with end-stage liver disease to seek transplantation abroad. For this reason, living donor liver transplantation (LDLT) became the primary type of liver transplantation, especially for children. 1,2 LDLT is being used with increasing frequency in adult patients 3,4 (Fig. 1).In this report, we summarize the experience with 308 adult living donor liver transplant recipients who underwent transplantation at 20 centers in Japan. Patients and Methods PatientsThree hundred eight adult patients underwent LDLT from January 1991 through December 1999. There were 200 women with a mean age of 40.8 years (range, 18 to 68 years) and 108 men with a mean age of 38.2 years (range, 18 to 64 years). Indications for LDLT were cholestatic liver diseases (n ϭ 129; 42%); chronic parenchymal liver disease, mainly caused by viral hepatitis (n ϭ 62; 20%); fulminant liver failure (n ϭ 54; 17%); metabolic liver diseases (n ϭ 43; 14%); and hepatobiliary malignancy (n ϭ 21; 7%; Fig. 2). Patients were followed up for a minimum of 3 months posttransplantation; survival and causes of mortality and morbidity were analyzed. Types of liver grafts, right lobe versus left lobe, and donor demographics were also determined.

Histidine-tryptophan-ketoglutarate versus University of Wisconsin solution in living donor liver transplantation: Results of a prospective study

“…9 Since 1998, adult-toadult LDLT using the right or the left liver has been performed in hundreds of patients. [10][11][12] To date there are no controlled data comparing the efficacy and safety of the two solutions in the perfusion of living donor grafts. Moreover, there are no guidelines regarding the optimal volume of solution that should be infused.…”

ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study

“…6,23 We also have avoided intrahepatic infusions (portal or arterial) proposed by some authors to control local and disseminated intravascular coagulation. 5,6 Although the recent development of immunosuppression has decreased AMR, the incidence of bacterial infections has increased becoming the most significant cause of death after ABOi LT. 5,14,2 In fact, one of our major complications was infection with the major consequence of MOF resulting in the deaths of 3 patients.…”

“…Emergency orthotopic liver transplantation (OLT) is the only durable life-saving treatment beyond the transitory supportive means of a critical care unit. ABO-incompatible liver transplantation (ABOi LT) which was reported in 1972 by Starz, 1 has gained acceptance in Asia, 2 North America, 3 and Europe. 4 Japan, the leading country performing ABOi LT to overcome the organs shortage, has investigated desensitization strategies.…”

“…4 Japan, the leading country performing ABOi LT to overcome the organs shortage, has investigated desensitization strategies. 2,5 ABOi transplantation remains a high-risk procedure performed only in cases lacking an available/compatible organ donor 6 or as a rescue option in emergency situations with the unavailability of a compatible graft. [7][8][9][10][11] Early results with adult ABOi LT were disappointing; patient and graft survivals were significantly worse than adult compatible OLT.…”

“…[7][8][9][10][11] Early results with adult ABOi LT were disappointing; patient and graft survivals were significantly worse than adult compatible OLT. 2,9,10 In 1988, Demetris et al reported a 46% graft failure rate during the first 30 days after primary ABOi LT compared with 11% with ABO compatibility. 12 In 1990, Guggenheim's group reported 30% graft function at 2 years after transplantation, whereas it was 76% for compatible ABO transplantations.…”