Early experiences on living donor liver transplantation in China: multicenter report.
BACKGROUND
Because of the lack of brain death laws in China, the proportion of cadaveric organ donation is low. Many patients with end-stage liver disease die waiting for a suitable donor. Living donor liver transplantation (LDLT) would reduce the current discrepancy between the number of patients on the transplant waiting list and the number of available organ donors. We describe the early experience of LDLT in the mainland of China based on data from five liver transplant centers.


METHODS
Between January 2001 and October 2003, 45 patients with end-stage liver disease received LDLT at five centers in China. The indication and timing, surgical techniques and complications, nonsurgical issues including rejection, infection, and advantages of LDLT in the series were reviewed. Actuarial patient and graft survival rates were calculated by using the Kaplan-Meier product-limit estimate. Statistical analysis was completed by using SPSS 10.0.


RESULTS
All LDLT recipients were cirrhotic patients, except for one man with fulminant hepatic failure. Among the 45 cases of LDLT, 35 (77.8%) were performed in one center (the First Affiliated Hospital of Nanjing Medical University). The overall 1 and 3 year survival rate of the recipients was 93.1% and 92.0%, respectively. Of the 45 LDLT donors, there were 3 cases of biliary leakage, 2 subphrenic collections, 1 fat liquefaction around the incision and 1 biliary peritonitis after T tube removal. All donors recovered completely.


CONCLUSIONS
LDLT provides an excellent approach to addressing the problem of donor shortage in China even though the operation is complicated, uncompromising and difficult with respect to the safety of the donors and receptors. Despite early technical hurdles having been overcome, perfection of technique is still necessarily. At present, LDLT is a good choice for the patients with irreversible liver disease.
Wang
Xue-hao
XH
Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China. drcsl@hotmail.com
Yan
Lü-nan
LN
Zhang
Feng
F
Li
Xiang-cheng
XC
Zhu
Ji-ye
JY
Peng
Zhi-hai
ZH
Liu
Jin-hui
JH
Li
Guo-qiang
GQ
Cheng
Feng
F
Sun
Bei-cheng
BC
Ge
Wen-gang
WG
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors