title: Outcomes of Living Donor Liver Transplantation Alone for Patients on Maintenance Renal Replacement Therapy in Japan: Results of a Nationwide Survey.
abstract: BACKGROUND
  Because simultaneous liver and kidney transplantation has been limited as a standard practice because of a severe shortage of deceased donors in Japan, living donor (LD) liver transplantation alone (LTA) is indicated in most recipients with maintenance renal replacement therapy (MRRT).
  
  
  METHODS
  A retrospective nationwide survey of LD LTA was performed for liver transplant patients on MRRT. The characteristics of donors and recipients, postoperative complications, survival rate, and causes of death were analyzed.
  
  
  RESULTS
  In the adult cases (n = 28), the overall survival rate at 1 year and 5 years were 66.1% and 57.3%, respectively. When compared with those adults without MRRT (n = 237), it was significantly worse. In the 7 pediatric cases, the overall survival rate at 1 and 5 years were both 83.3%. Three adult recipients died of nonaneurysm cerebral hemorrhage after 1 year and 1 adult recipient died of acute heart failure after 7 months. In adult recipients with MRRT, graft weight versus standard liver volume, and duration and blood loss in LTA surgery were associated with poor outcomes after LD LTA. Multivariate analysis revealed that MRRT was highest hazard ratio on patient survival after LD LTA.
  
  
  CONCLUSIONS
  Early post-LD LTA mortality was higher in patients with MRRT than in those without MRRT with characteristic causes. Smaller grafts for size and a complicated surgery were associated with poor outcome after LD LTA. Thus, LD LTA in adult patients on MRRT should be carefully treated with meticulous postoperative management and follow-up.
authors: Departments of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors: Susumu
authors: S
authors: Eguchi
authors: Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan.
authors: Hiroyuki
authors: H
authors: Furukawa
authors: Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors: Shinji
authors: S
authors: Uemoto
authors: Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Koji
authors: K
authors: Umeshita
authors: Departments of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors: Hajime
authors: H
authors: Imamura
authors: Departments of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors: Akihiko
authors: A
authors: Soyama
authors: Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Japan.
authors: Tsuyoshi
authors: T
authors: Shimamura
authors: Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Tsu, Japan.
authors: Shuji
authors: S
authors: Isaji
authors: Department of Transplant Surgery, Nagoya University Hospital, Nagoya, Japan.
authors: Yasuhiro
authors: Y
authors: Ogura
authors: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors: Hiroto
authors: H
authors: Egawa
authors: Department of Digestive Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan.
authors: Shigeyuki
authors: S
authors: Kawachi
authors: Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
authors: Mureo
authors: M
authors: Kasahara
authors: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Hiroaki
authors: H
authors: Nagano
authors: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors: Yonson
authors: Y
authors: Ku
authors: Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
authors: Hideki
authors: H
authors: Ohdan
authors: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Yoshihiko
authors: Y
authors: Maehara
authors: Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan.
authors: Shuntaro
authors: S
authors: Sato
authors: Department of Transplantation and Pediatric Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
authors: Yukihiro
authors: Y
authors: Inomata