Abstract
Over the past quarter-century, liver transplantation has been established as a durable therapy for all forms of end-stage liver disease. Hepatitis C virus (HCV) infection remains the most common cause of hepatic failure requiring liver transplantation. Unfortunately however, without viral eradication before transplantation, HCV recurrence is universal and associated with poor graft and patient survival. Despite attempts to suppress HCV activity with various pretransplant and posttransplant antiviral therapies, many questions remain.
Moreover, liver transplantation is considered the optimal treatment for small HCC, especially in patients with underlying chronic liver disease, since liver transplantation based on the Milan criteria has been shown to provide good disease-free survival.
Living donor liver transplantation (LDLT) has been controversial since its inception. Begun in response to deceased donor organ shortage and waiting list mortality, LDLT was initiated in 1989 for pediatric cases, and then grew rapidly after its first general application in adults in Japan in 1993;however, systematic data collection using a consistent and accepted classification system in the large multicenter study has documented the frequency and severity of complications among adult LDLT donors and its use has declined since 2001 in the US.
In Japan LDLT comprises about 99% of liver transplantation. Although left-lobe grafts can sometimes be small-for-size and the concept of left-lobe donation for adult recipients has now been almost completely abahdoned in Western countries, the optimal graft size for adult patients remains unclear.We have used a left-lobe graft exclusively, and have not performed right-lobe LDLT, as there is no doubt that right hepatic lobectomy places a serious burden on the donor.Thirty-three adult patients made good progress and the 1-year and 5-year patient survival rates were 100% and 95%.Left-lobe graft LDLT is still an important treatment option for adult patients.
