Living donor liver transplantation in Japan and Kyoto University: what can we learn?
Section snippets
Overview of LDLT in Japan and Kyoto University Hospital
According to the registry of the Japanese Liver Transplantation Society, 2249 liver transplants have been performed until the end of 2002 in 49 institutions in Japan. One and three year survival in LDLT are 80.8 and 78.5%, respectively [3].
LDLT was first introduced in Kyoto University Hospital in June 1990. By June 2004 the number of LDLT reached 1000 including 387 adults and 613 children (Fig. 1). In pediatric recipients, the etiology of liver disease was: cholestatic disease (72%), metabolic
Donor morbidity and mortality
The Japanese Liver Transplantation Society has published donor morbidity and mortality rates through data obtained via a questionnaire sent to the 46 liver transplant centers where the operations have been performed [4]. Data were obtained anonymously so as not to invade donor privacy. Approval for the study was granted by the society's ethics committee. From November 1989 to April 11, 2002, 1852 LDLT donors were registered in the database and no perioperative donor deaths have been recorded
Development of surgical techniques
We have developed many innovative techniques for LDLT since the inception of this procedure. Initially, LDLT was restricted to pediatric recipients. Lateral segmentectomy was performed because it carried less risk for the donor and the volume of lateral segment provided adequate hepatocyte mass for pediatric patients [5]. The incidence of hepatic artery thrombosis (HAT) in pediatric liver transplantation was reported to range between 15 and 20% [6], most of whom would require re-transplantation
Summary
Although brain death law was established in Japan in 1997, still only a few livers from deceased donors are available and LDLT still remains the main therapeutic option for patients with end stage liver disease. LDLT is widely available in Japan and is performed in adults as well as children. According to a registry maintained by the Japanese Liver Transplantation Society, 2249 transplants have been performed in 49 institutions throughout Japan until the end of 2002 [3]. There were 2226 LDLTs
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