Abstract
In 1992, we started a program on living-donor liver transplantation(LDLT)at Keio University that aimed to apply basic research to clinical practice. Basic research focused on microcirculation, free radicals, and cytokines to elucidate the mechanism and treatment of ischemiareperfusion injury. Experimental liver transplantations were performed on pigs in preclinical trials,which showed that intraportal administration of prostaglandin E1(PGE1)mitigated ischemiareperfusion injury and helped maintain positive graft liver circulation and function. In addition, in vivo fluorescence microscopy was used to visualize the beneficial role of PGE1 in the suppression of leukocyte adhesion to the vascular endothelium and in the improvement of microcirculation in the liver. This research was translated to the clinical practice of adult LDLT and intraportal infusion therapy for ABO-incompatible liver transplantation. The first LDLT at Keio University Hospital was performed on April 3, 1995. The patient developed jaundice after the surgery and had to be hospitalized for approximately 3 months, but was later discharged uneventfully and is now in good health. In November 1998, the first adult ABO-incompatible LDLT was performed. To prevent single organ DIC that occurs in the graft, intraportal infusion of PGE1, gabexate mesilate, and steroids was decided based on the aforementioned basic research. In my 11 years at Keio, I performed 119 LDLTs in 116 patients, achieving a 5-year survival rate of 84.3% overall, 87.2% in children, and 82.3% in adults, which were all higher than the corresponding national averages. For the 19 patients (12 adults, 7 children) in whom I performed ABO-incompatible liver transplantationLDLTs, the 5-year survival rate was 78.9%, which is not significantly different from the 83.1% for compatible cases. At Tokyo Medical University, I successfully resumed the LDLT program in 2012 with the assistance of the staff, which had been put on hold.
