BACKGROUND: Living donors are practically the only source of organs in countries where the availability of cadaveric donors is severely restricted, such as Japan. A left-lobe graft, in which one third of the liver is donated, is therefore used for adult-to-adult living-donor liver transplantation (LDLT) in patients with fulminant hepatic failure (FHF). METHODS: Fifteen adult patients with FHF, ranging from 22 to 59 years of age, were treated with LDLT with a left-lobe graft. Preoperative encephalopathy was grade II in 2 patients, grade III in 4 patients, and grade IV in 9 patients. The graft volume (GV) ranged from 260 to 570 mL, thus corresponding to 23% to 54% of the recipients' standard liver volume (SLV). The patients were divided into 2 groups according to their GV/SLV: a medium-size graft group (GV/SLV > or =30%; group M, n = 11) and a small-size graft group (GV/SLV <30%; group S, n = 4). The effects of GV/SLV on graft function and survival were compared. Postoperative neurologic complications were also evaluated. RESULTS: The donors are all doing well. Twelve (80%) of the 15 recipients are still alive, with a follow-up period of from 3 to 43 months. No statistically significant differences were observed in the postoperative serum levels of bilirubin and alanine aminotransferase, prothrombin time, or frequency of postoperative complications between the 2 groups. The graft and patient survival rates were 75% (3/4) and 75% (3/4) in group S and 73% (8/11) and 82% (9/11) in group M, respectively. All patients who survived the perioperative period recovered without any neurologic sequelae. CONCLUSIONS: The high success rate and low donor risk of LDLT may therefore justify its use for adult patients with FHF using a left-lobe graft.
BACKGROUND: Living donors are practically the only source of organs in countries where the availability of cadaveric donors is severely restricted, such as Japan. A left-lobe graft, in which one third of the liver is donated, is therefore used for adult-to-adult living-donor liver transplantation (LDLT) in patients with fulminant hepatic failure (FHF). METHODS: Fifteen adult patients with FHF, ranging from 22 to 59 years of age, were treated with LDLT with a left-lobe graft. Preoperative encephalopathy was grade II in 2 patients, grade III in 4 patients, and grade IV in 9 patients. The graft volume (GV) ranged from 260 to 570 mL, thus corresponding to 23% to 54% of the recipients' standard liver volume (SLV). The patients were divided into 2 groups according to their GV/SLV: a medium-size graft group (GV/SLV > or =30%; group M, n = 11) and a small-size graft group (GV/SLV <30%; group S, n = 4). The effects of GV/SLV on graft function and survival were compared. Postoperative neurologic complications were also evaluated. RESULTS: The donors are all doing well. Twelve (80%) of the 15 recipients are still alive, with a follow-up period of from 3 to 43 months. No statistically significant differences were observed in the postoperative serum levels of bilirubin and alanine aminotransferase, prothrombin time, or frequency of postoperative complications between the 2 groups. The graft and patient survival rates were 75% (3/4) and 75% (3/4) in group S and 73% (8/11) and 82% (9/11) in group M, respectively. All patients who survived the perioperative period recovered without any neurologic sequelae. CONCLUSIONS: The high success rate and low donor risk of LDLT may therefore justify its use for adult patients with FHF using a left-lobe graft.
Authors: Jeffrey Campsen; Andres T Blei; Jean C Emond; James E Everhart; Chris E Freise; Anna S Lok; Sammy Saab; Karen A Wisniewski; James F Trotter Journal: Liver Transpl Date: 2008-09 Impact factor: 5.799