Liver Transplantation In Asia Research Articles

Hepatitis B core antibody-positive grafts: recipient's risk.

The transmission of hepatitis B virus infection through hepatitis B core antibody (anti-HBc)-positive liver grafts in hepatitis B surface antigen (HBsAg)-negative recipients has been established. The mandatory use of immunosuppression in transplant patients favors reactivation of latent virus that may be present in grafts from HBsAg-negative anti-HBc-positive donors. With the persistent organ donor scarcity, the use of these grafts cannot be avoided, especially in urgent cases and in areas where the prevalence of the hepatitis B virus is high, as in Asia. The recognition of posttransplant de novo hepatitis B from core antibody-positive liver donors has, therefore, led to modifications in graft allocation policies and the introduction of strategies for prophylaxis. The risk of developing this type of new-onset hepatitis B virus infection in liver transplant recipients and the various approaches to minimize this risk are reviewed. The peculiar implications of using core antibody-positive grafts in the context of living donor liver transplantation in Asia are discussed.

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.

Complications and long-term outcome of living liver donors: a survey of 1,508 cases in five Asian centers.

A multicenter survey was conducted regarding the safety and outcome of living liver donors in Asia. Five Asian liver transplant centers reported a total of 1,508 living donor liver transplantations (LDLT) performed between January 1990 and December 2001. The recipients consisted of 766 adults and 742 children. The graft types were left lateral or extended left lateral segment in 605, left lobe in 334, right lobe or right lateral sector in 561, and not classified in eight cases. The donor blood loss was less than 1,000 mL in 94.1% of the cases, and 0.53% of the donors received banked blood transfusion. The overall donor complication rate was 15.8%, and 1.1% of donors underwent reoperation. The complication rate was higher in right lobe (28%) than in left lateral segment (9.3%) or left lobe (7.5%) donors. In particular, right lobe donors had more serious complications such as cholestasis (7.3%), bile leakage (6.1%), biliary stricture (1.1%), portal vein thrombosis (0.5%), intra-abdominal bleeding (0.5%), and pulmonary embolism (0.5%). There was no hospital mortality, but there was one late donor death 3 years after operation. Long-term follow-up beyond 3 months was available in 15.1% of the donors only. The data from the multicenter study set the standard for the safety of living liver donors in high-volume liver transplant centers in Asia and provide further justification for the continued application of LDLT in the face of the critical organ shortage in Asia. The long-term outcome of liver donation, however, remains unknown, and transplant centers should continue their follow-up of donors.

Split liver transplantation in Asia

Split liver transplantation in Asia

Indications for liver transplantation in patients with chronic hepatitis B and C virus infection and hepatocellular carcinoma.

Patients with chronic hepatitis B virus (HBV) infection were not accepted for liver transplantation in Asia in the past because the hepatitis B immune globulin (HBIG) used to prevent post-transplantation recurrence was very expensive and it was generally believed that Asians with hepatitis B fared worse than Caucasians after liver transplantation. The availability of lamivudine has altered the indication of liver transplantation for these patients. Twenty-five Chinese patients with chronic HBV infection were given lamivudine as primary prophylaxis against HBV re-infection before transplantation. Five patients died within 40 days of transplantation. After a median follow-up period of 14 months (range, 5-39), 17 patients had lost serum HBsAg from 4 days to 27 months post transplantation, but it reappeared in three patients 4-12 months later. Antibody to HBsAg was detected periodically in the serum of 1 patients who had lost HBsAg. At the last follow-up, six patients were HBsAg-positive and HBV DNA was detected in only one of them. The indication for liver transplantation for chronic hepatitis C virus (HCV) infection is not as strict as for patients with chronic HBV infection because the long-term survival is similar to that of non-hepatitis C patients, even though re-infection by HCV in the recipients is nearly universal. The main issue in the selection of patients with HCV for liver transplantation is therefore identification of criteria that can predict re-infection and development of cirrhosis. These include factors such as multiple episodes of rejection, use of OKT3, pre-transplant viral load and genotype, but reports are not consistent and so there are no well-defined selection criteria. The selection criteria for patients with hepatocellular carcinoma are now well defined. Many studies have confirmed that a tumour > 5 cm, and showing vascular invasion, and poor differentiation adversely affects survival. In practice, only patients with a tumour < 5 cm and Child's C cirrhosis are accepted for liver transplantation. Transarterial oily chemoembolization and intralesional alcohol injection are used to control or down-stage the tumour while patients wait for a cadaveric liver graft.

Liver transplantation in Asia: Problems and practice.

Liver transplantation in Asia has been difficult to establish due to: a reluctance in Asians to donate organs; a lack of financial support; and the predominance of hepatitis B in the population, which effectively reduces the number of cadaveric organs. To overcome the problem of organ shortage, living-related liver transplantation for paediatric patients was rapidly established initially at Kyoto University, Japan, and then in several centres in Asia. Living-related liver transplantation was extended to adults using the left lobe in 1994 and using the right lobe in 1996. Up to May 1998, 785 liver transplantations had been performed in major centres in Asia with a patient survival rate approaching 80%. To overcome the problem of hepatitis B viral infection, lamivudine is now used peri-operatively. Lamivudine is shown to be very effective in preventing graft reinfection. Of the 15 patients who received lamivudine and liver transplantation at Queen Mary Hospital, hepatitis B surface antigen (HBsAg) disappeared in 11 patients and hepatitis B virus DNA was not detectable in any of them. Two patients had a reappearance of HBsAg after an initial loss, but their liver grafts were not affected by hepatitis. Compared with hepatitis B immunoglobulin, lamivudine is definitely cheaper and more convenient. In conclusion, even though there are major obstacles to liver transplantation in Asia, steady progress is being made. Hopefully, when the number of cadaveric grafts increases in future, an increasing number of patients can benefit.

Liver transplantation in Asia: Problems and practice

Liver transplantation in Asia has been difficult to establish due to: a reluctance in Asians to donate organs; a lack of financial support; and the predominance of hepatitis B in the population, which effectively reduces the number of cadaveric organs. To overcome the problem of organ shortage, living‐related liver transplantation for paediatric patients was rapidly established initially at Kyoto University, Japan, and then in several centres in Asia. Living‐related liver transplantation was extended to adults using the left lobe in 1994 and using the right lobe in 1996. Up to May 1998, 785 liver transplantations had been performed in major centres in Asia with a patient survival rate approaching 80%. To overcome the problem of hepatitis B viral infection, lamivudine is now used peri‐operatively. Lamivudine is shown to be very effective in preventing graft reinfection. Of the 15 patients who received lamivudine and liver transplantation at Queen Mary Hospital, hepatitis B surface antigen (HBsAg) disappeared in 11 patients and hepatitis B virus DNA was not detectable in any of them. Two patients had a reappearance of HBsAg after an initial loss, but their liver grafts were not affected by hepatitis. Compared with hepatitis B immunoglobulin, lamivudine is definitely cheaper and more convenient. In conclusion, even though there are major obstacles to liver transplantation in Asia, steady progress is being made. Hopefully, when the number of cadaveric grafts increases in future, an increasing number of patients can benefit.