Experience Of Living Donor Liver Transplantation Research Articles

Early experiences on living donor liver transplantation in China: multicenter report

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. 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. 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. 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.

Living-donor liver transplantation: 12 years of experience in Asia.

Living-donor liver transplantation has provided a solution to the severe lack of cadaveric grafts for the replacement of livers afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. The pioneering experience in Japan in the early 1990s helped open wide the avenues of a new branch of science that is technically demanding and whose benefits are clearly dramatic. The need for alternative sources of liver grafts was common to the entire Asian region and, fortunately, the option of obtaining partial liver grafts from live donors had already become tenable. By the second half of the past decade, living-donor liver transplant programs had been successfully established in Hong Kong, Taiwan, and Korea. More than 1,500 cases have been performed over a 12-year period. This report describes the cumulative experience in living-donor liver transplantation in Asia on the basis of data from five major liver transplant centers.

EDITORS??? COMMENTS

The Editors of Transplantation® are particularly pleased to publish this supplement because it represents the unique, collective experience of over 1,500 living-donor liver transplants in Asia. We welcome, as Guest Editor of this supplement, Professor Chao-Long Chen of Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan. Professor Chen is one of the pioneer liver transplant surgeons in Asia and is responsible for spearheading the publication of this supplement. The papers presented in this symposium offer our readers an overview on the current status of living-donor liver transplantation in Asia. The safety standard of the donor operation is of special concern. The various technical innovations in graft design and vascular reconstruction are also presented in detail. In addition, the ethical issues unique to Asian countries and the controversies in applying the operation to patients with malignancy or hepatitis B and in high urgency situations are addressed. The Editors feel that the extensive experience in living-donor liver transplantation described in this symposium will help liver transplant surgeons and physicians to refine the practice of living-donor liver transplantation not only in Asia but in other parts of the world.