Living donor liver transplantation in Kyoto, 2001.
The living-donor liver transplant program at Kyoto University Hospital entered its 12th year in 2001. The rapid increase in adult patients that occurred with active use of right hemi-liver grafts is now reaching its plateau, limited by OR facilities and bed capacity. Graft selection is now being polarized to the left lateral section and right hemi-liver, and disease indications are becoming more similar to those for Western cadaveric programs, including a program for hepatocellular carcinoma. With the active introduction of right hemi-liver grafts, donor selection requires more multifactorial attention. Although most anatomical variants are managed surgically without significant risk, small-for-size grafts combined with high-risk patients are often a continuing problem even with the use of right hemi-liver grafts. Solutions for small-for-size syndrome with or without persistent portal hypertension and massive ascites are urgent targets of research. It will take some more time in Japan until the final establishment of a mutual compensatory system between cadaveric and living donor programs covering medical and socioeconomical aspects is achieved.
Kiuchi
T
T
Department of Transplant Surgery, Organ Transplant Unit, Kyoto University Hospital, Kyoto, Japan.
Uemoto
S
S
Egawa
H
H
Kaihara
S
S
Oike
F
F
Yokoi
A
A
Ogura
Y
Y
Kasahara
M
M
Fujimoto
Y
Y
Kozaki
K
K
Tanaka
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D006509:Hepatitis B; D006526:Hepatitis C; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008875:Middle Aged; D012086:Reoperation; D014019:Tissue Donors; D016896:Treatment Outcome