title: Living-donor liver transplantation for fulminant hepatic failure in adult patients with a left-lobe graft.
abstract: 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.affiliation: Graduate School of Medical Sciences, Kyushu University, and Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishizaki
authors.forename: Shoji
authors.initials: S
authors.lastname: Hiroshige
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications; D011517:Prothrombin Time; D016896:Treatment Outcome
chemical_list: D000410:Alanine Transaminase; D001663:Bilirubin