title: Outcomes of adult-to-adult living donor liver transplantation: a single institution's experience with 335 consecutive cases.
abstract: OBJECTIVE
  To determine outcomes for both donors and recipients of adult-to-adult living donor liver transplantation (AALDLT) and independent factors impacting those outcomes.
  
  
  BACKGROUND
  Deceased donors for organ transplantation remain extremely rare, making living donor liver transplantation (LDLT) practically the sole therapeutic modality for patients with end-stage liver disease in Japan.
  
  
  METHODS
  Retrospective analysis of initial LDLT for 335 consecutive adult (>or=18 years) patients performed between November 1994 and December 2003.
  
  
  RESULTS
  : Of the 335 recipients, 275 received right-liver grafts and the remaining 60 recipients received non-right-liver grafts. Three of the 335 liver grafts were domino-splitting livers. Sixty of the 332 donors other than the domino-donors showed major postoperative complications. Multivariate analysis indicated that accumulation of case experience significantly and advantageously affected the surgical outcomes of these living liver donors, and right-liver donation and prolonged donor operation time were shown to be independent risk factors of major complications in the donors. Post-transplant patient and graft survival estimates were 73.1% and 72.5% at 1 year, 67.7% and 66.3% at 4 years, and 64.7% and 61.9% at 7 years, respectively. Obvious pretransplant encephalopathy, a higher (>or=31) modified Model for End-stage Liver Disease score (including points for persistent ascites and low serum sodium) and higher donor age (>or=50 years) were indicated as independent factors predictive of graft failure (graft loss or death) in the multivariate analysis.
  
  
  CONCLUSIONS
  Graft type and degree of experience exerted a significant impact on the surgical outcomes of AALDLT donors but did not significantly affect the survival outcomes of AALDLT recipients. Better pretransplant conditions and younger age (<50 years) among the living donors appeared to be advantageous in terms of gaining better survival outcomes of patients undergoing AALDLT.
authors.affiliation: Organ Transplant Unit, Kyoto University Hospital, Kyoto, Japan. dmorioka@hotmail.com
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Ito
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007564:Japan / Q000453:epidemiology; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome