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Present status and prospects of living-related liver transplantation

  • Review Article
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Living-related liver transplantation (LRLT) is a relatively new surgical modality that has developed, in part, to overcome the shortage of available cadaveric livers for transplantation and as a method to provide liver graft implants from living donors for patients end-stage with liver disease in areas where the use of cadaveric livers is not yet practiced or permitted. Since 1988 almost 500 LRLTs have been performed globally. The safety of donors who provide a portion of their liver for grafting is of utmost concern, and only one donor death from this procedure has been reported in the literature. Postoperative survival in recipients depends on their pretransplant physical status, but emergency patients in rapid need of a liver have a poorer survival than elective LRLT patients for whom survival is about 80%. Children and infants are the main recipients of LRLTs, but adult patients particularly in Japan, are increasing in number, and present indications for LRLT surgery include not only cholestatic end-stage liver diseases but also metabolic disorders affecting the liver and emergency LRLTs for fulminant hepatic failure. Many ethical problems relating to the concept of liver transplantation, donor liver source, recipient selection, and reimplantation have yet to be resolved. But we believe that LRLTs and cadaveric liver transplantations are saving lives and that the practice should be continued.

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References

  1. Emond JC, Whitington PF, Thistlethwaite JR, Alonso EM, Broelsch CE (1989) Reduced-size orthotopic liver transplantation: Use in the management of children with chronic liver disease. Hepatology 10:867–872

    PubMed  Google Scholar 

  2. Wood PR, Katz SM, Ozaki CF, Monsour HP, Clark J, Ferraresso M, Baumann L, Thomas M, Weldon M, Hoef J, Fontenot D, Lyon H (1993) Development of the living-related donor liver transplant program at the Texas Medical Center: Initial results and surgical complications. Transplant Proc 25:50–52

    PubMed  Google Scholar 

  3. Bismuth H, Houssin D (1984) Reduced-sized orthotopic liver graft in hepatic transplantation in children. Surgery 95:367–370

    PubMed  Google Scholar 

  4. Broelsch CE, Emond JC, Thistlethwaite JR, Whitington PF, Zucker AR, Baker AL, Aran PF, Rouch DA, Lichtor JL (1988) Liver transplantation, including the concept of reduced-size liver transplants in children. Ann Surg 208:410–420

    PubMed  Google Scholar 

  5. Ringe B, Pichlmayr R, Burdelski M (1988) A new technique of hepatic vein reconstruction in partial liver transplantation. Transplant Int 1:30–35

    Google Scholar 

  6. Strong RW, Lynch SV, Ong TH, Matsunami H, Koido Y, Balderson GA (1990) Successful liver transplantation from a living donor to her son. New Engl J Med 322:1505–1507

    PubMed  Google Scholar 

  7. Otte JB, de Ville de Goyet J, Sokal E, Arberti D, Moulin D, de Hemptinne B, Veyckemans F, van Obbergh L, Carlier M, Clapuyt P (1990) Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organs in pediatric liver transplantation. Ann Surg 211:146–157

    PubMed  Google Scholar 

  8. Pichlmayr R, Ringe B, Gubernatis G, Hauss J, Bunzendahl H (1988) Transplantation einer Spenderleber auf zwei Empfanger (splitting transplantation): Eine neue methode in der weiterentwicklung der lebersegment. Transplantation 373:127–130

    Google Scholar 

  9. Emond JC, Whitington PF, Thistlethwaite JR, Cherqui D, Alonso EA, Woodle IS, Vogelbach P, Busse Henry SM, Zucker AR, Broelsch CE (1990) Transplantation of two patients with one liver: Analysis of preliminary experience with “split-liver’ grafting Ann Surg 212:14–22

    PubMed  Google Scholar 

  10. Raia S, Nery JR, Mies S (1989) Liver transplantation from live donors. Lancet 26:497

    Google Scholar 

  11. Nagasue N, Kohno H, Matsuo S, Yamanoi A, Uchida M, Takemoto Y, Nakamura T (1992) Segmental (partial) liver transplantation from a living donor. Transplant Proc 24:1958–1959

    PubMed  Google Scholar 

  12. Heffron TG, Monsour HP, Tokunaga Y, Rogiers X, Katz SM, Belani KG (1993) In: Proceedings of the first international congress of pediatric transplantation. Minneapolis, Minnesota USA

  13. Broelsch CE, Whitington PF, Emond JC, Heffron TG, Thistlethwaite JR, Stevens L, Piper J, Whitington SH, Lichtor JL (1991) Liver transplantation in children from living-related donors. Surgical techniques and results. Ann Surg 214:428–438

    PubMed  Google Scholar 

  14. Emond JC, Heffron TG, Kortz EO, Gonzalez Vallina R, Contis JC, Black DD, Whitington PF (1993) Improved results of livingrelated liver transplantation with routine application in a pediatric program. Transplantation 55:835–840

    PubMed  Google Scholar 

  15. UNOS Managing editor (1993) Numbers of Transplants performed in the U.S. by organ, year, and type of donor. UNOS Update 9:(5) May 43

  16. Belle SH, Beringer KC, Detre KM (1995) Liver transplantation in the United States: Results from the national Pitt-UNOS liver transplant registry. Clin Transplants 1994:19–35

    Google Scholar 

  17. Esquivel CO, Martinez O, Kraus S, et al. (1995) Liver transplantation at California Medical Center, San Francisco, Calfornia. Clinical Transplants 1994, 163–172

  18. Jurim O, Shackleton RC, McDiarmid VS, Martin P, Shaked A, Millis MJ, Imagawa KD, Olthoff KM, Maxfield ARN, Pakrasi LA, Bsn RN, Melinek J, BA Ament M, Vargas J (1995) Living-Donor liver transplantation at UCLA. Am J Surg 169:529–532

    PubMed  Google Scholar 

  19. Terasaki PI, Cecka JM, Gjertson DW (1994) Current world opinion regarding the use of living donors. Clinical Transplants 1993: 341–343

    Google Scholar 

  20. Harmon W (1993) Pediatric Transplantation Committee reports UNOS Update 9:11–12

    Google Scholar 

  21. Reding R, de Ville de Goyet J, Sokol E, Otte JB (1996) Brussels experience with living-related liver transplantation (LRLT). The first 30 cases. In: Proceedings of PAPS 29th annual meeting, Singapore

  22. Habib NA, Higgs BD, Marwan I, el Masy R, Helmi A, Saifi R, Abdel Wohab F, Abaza A, Koensa H (1993) Living related liver transplantation in Africa. Int Surg 78:121–123

    PubMed  Google Scholar 

  23. Haberal M. Büyükpamukgu N, Bilgin N, et al. (1994) Segmentai living related liver transplantation in pediatric patients Transplantation Proc. 26:183–184

    Google Scholar 

  24. Lee SG, Lee YG, Park KM, Kim KM (1996) Living-related iver transplants: The Seoul experience. In: Proceedings of International Symposium on Living Related Liver Transplantation, Kaohsiung, Taiwan

  25. Chen CL, Chen YS, Liu PP, Chiang YC, Sun CK (1996) Livingrelated liver transplantation: The Kaohsiung experience. International Symposium on Living-Related Liver Transplantation, Kaohsiung, Taiwan

  26. Saing H, Fan ST, Chan KL, Wei WI, Lo CM, Mya GH, Tsoi NS, Lo JWR, Chau MT, Tsoi WK, Chan J, Ng IOL, Yuen KY, Wong J (1996) Liver transplantation in children: The Queen Mary Hospital, Hong Kong Experience. In: Proceedings of the 29th Annual Meeeting of the Pacific Association of Pediatric Surgeons, Singapore

  27. Otle J and Houssin D (Chairman) (1991) In: Proceedings of 5th European Society of Organ Transplantation 62–66, Maastricht, the Netherlands

  28. Ozawa K, Uemotmo S, Tanaka K, Kumada K, Yamaoka Y, Kobayashi N, Inamoto T, Shimahara Y, Mori K, Honda K (1992) An appraisal of pediatric liver transplantation from living relatives: Initial clinical experiences in 20 pediatric liver transplantations from living relatives as donors. Ann Surg 216:547–553

    PubMed  Google Scholar 

  29. Makuuchi M, Kawarazaki H, Iwanaka T, Kamada N, Takayama T, Kumon M (1992) Living-related liver transplantation. Surgery Today 22:297–300

    PubMed  Google Scholar 

  30. Makuuchi M, Kawasaki S (1996) Living-related liver transplantation in adults. In: Proceedings of international symposium on living-related liver transplantation, Kaohsiung, Taiwan

  31. Heffron TG (1995) Living-related liver transplantation. Semin Liver Dis 15:165–172

    PubMed  Google Scholar 

  32. Otte JB (May 1996) The current status of liver transplantation for biliary atresia. In: Proceedings of the 6th International Sendai Symposium on Biliary Atresia. Sendai, Japan

  33. Morimoto T, Ichimiya M, Tanaka M, Ikai I, Yamamoto Y, Nakamura Y, Takada Y. Inomata Y. Honda. K, Inamoto T, Tanaka K, Yamaoka Y (1996) Guidelines for donor selection and an overview of the donor operation in living-related liver transplantation. Transplant Int 9:208–213

    Google Scholar 

  34. Monsour HP Jr, Wood RP, Ozaki C, Katz S, Clark J, Dyer C, Camel S (1994) Utility of preoperative liver biopsy in live-related donor patients for liver transplantation. Transplant Proc 26:138–139

    PubMed  Google Scholar 

  35. Mori K, Nagata I, Yamagata S, Sasaki H, Nishizawa F, Takada Y, Moriyasu F, Tanaka K, Yamaoka Y, Kumada K (1992) The introduction of microvascular surgery to hepatic artery reconstruction in living-donor liver transplantation: Its surgical advantages compared with conventional procedures. Transplantation 54:263–268

    PubMed  Google Scholar 

  36. Shimahara Y, Awane M, Yamaoka Y, Tanaka K, Morimoto T, Mori K, Higashiyama H, Yamaguchi T, Kumada K, Takada Y (1992) Analyses of the risk and operative stress for donors in living-related partial liver transplantation. Transplantation 54:983–988

    PubMed  Google Scholar 

  37. Yamaoka Y. Ozawa K, Tanaka A, Mori K, Morimoto T, Shimahara Y, Zaima M, Tanaka K, Kumada K (1991) New devices for harvesting a hepatic graft from a living donor. Transplantation 52:157–160

    PubMed  Google Scholar 

  38. Makuuchi M, Kawasaki S, Noguchi T, Hashikura Y, Matsunami H, Hayashi K, Harada H, Kakazu T, Takayama T, Kawarasaki H (1993) Donor hepatectomy for living-related partial liver transplantation. Surgery 113:395–402

    PubMed  Google Scholar 

  39. Morimoto T, Yamaoka Y, Tanaka K, Tanaka A, Ikai I, Takada Y, Yamamoto Y, Nakamura Y, Inomata Y, Honda K, Inamoto T, Shimahara Y, Ozawa K (1994) Questionnaire to donors participating in living-related liver transplantation with regard to postoperative quality of life. J Transplant Coordination 4:126–131

    Google Scholar 

  40. Rogiers X, Shroeder T, Tuttlewski K, Broelsch C (1996) First report of the International living donor liver registry. In: Proceedings of 16th International Congress of the Transplantation Society, Barcelona, Spain

  41. Goldman LS (1993) Liver transplantation using living donors. Preliminary donor psychiatric outcomes Psychosomatics 34:235–240

    PubMed  Google Scholar 

  42. Malatack JJ, Schaid DJ, Urbach AH, Gärtner Jc, Zitelli BJ, Rockette H, Fischer J, Starzl TE, Iwatsuki S, Shaw BW (1987) Choosing a pediatric recipient for orthotopic liver transplantation. J Pediatr 111:479–489

    PubMed  Google Scholar 

  43. Heffron TG, Emond JC (1992) Segmentall liver transplantation in children: Reduced size cadaveric, split, and Living-related. Transplant Science 2:28–33

    Google Scholar 

  44. Kimura K, Inomata Y (1996) Biliary atresia. In: Donnellan WL (ed) Abdominal surgery of infancy and childhood. Hawood Academic, Luxembourg, pp 32/1–32/13

    Google Scholar 

  45. Fujita S, Tanaka K, Uemoto S, Sano K, Manaka D, Shirahase I, Shinohara H, Yamaoka Y, Ozawa K (1993) Living-related liver transplantation for biliary atresia. Clin Transplant 7:571–577

    PubMed  Google Scholar 

  46. Fujimoto M, Moriyasu F, Someda H, Nada T, Okuma M, Inomata Y, Tanaka K, Yamaoka Y (1995) Evaluation of portal hemodynamics with Doppler ultrasound in living-relatred donor liver transplantations in children: Implications for ligation of spontaneous collateral pathways. Transplant Proc 27:1174–1176

    PubMed  Google Scholar 

  47. Chiba T (1988) Indications of Kasai's operation for biliary atresia: For early decision of liver transplantation. Arch Jpn Chir 57:261–266

    Google Scholar 

  48. Houssin D, Soubrane O, Boillot O, Dousset B, Ozier Y, Devictor D, Bernard O, Chapuis Y (1992) Orthotopic liver transplantation with a reduced-size graft: An ideal compromise in pediatrics? Surgery 111:532–542

    PubMed  Google Scholar 

  49. Yamaoka Y, Washida M, Honda K, Tanaka K, Mori K, Shimahara Y, Okamoto S, Ueda M, Hayashi M, Tanaka A, Morimoto T, Ozawa K (1994) Liver transplantation using a right lobe from a living-related donor. Trasnplantation 57:1127–1130

    Google Scholar 

  50. Higashiyama H, Yamaguchi T, Mori K, Nakano Y, Yokoyama T, Takeuchi T. Yamamoto N, Yamaoka Y, Tanaka K, Kumada K (1993) Graft size assessment by preoperative computed tomography in living-related partial liver transplantaiton. Br J Surg 80:489–492

    PubMed  Google Scholar 

  51. Urata K, Kawasaki S, Matsunami H, Hashikura Y, Ikegami T, Ishizone S, Momose Y, Komiyama A, Makuuchi M (1995) Calculation of child and adult standard liver volume for liver transplantaiton. Hepatology 21:1317–1321

    PubMed  Google Scholar 

  52. Inomata Y, Tanaka K, Okajima H, Uemoto S, Ozaki N, Egawa H, Satomura K, Kiuchi T, Yamaoka Y (1996) Living-related liver transplantation for children younger than 1 year old. Eur J Pediatr Surg 6:148–151

    PubMed  Google Scholar 

  53. Strong R, Lynch S, Yamanaka J, Kawamoto S, Pilly P, Ong TH (1995) Monosegmental liver transplantation. Surgery 118: 904–907

    PubMed  Google Scholar 

  54. Emond JC, Heffron TG, Whitington PF, Broelsch CE (1993) Reconstruction of the hepatic vein in reduced-size hepatic transplantation. Surg Gynecal Obstetr 176:11–17

    Google Scholar 

  55. Takayama T, Makuuchi M, Kawasaki S, Ishizone-S, Matsunami H, Iwanaka T, Kqwarasaki H (1994) Outflow Y-reconstruction for living-related partial hepatic transplantation. J Am Coll Surg 179:227–229

    Google Scholar 

  56. Yamaguchi T, Yamaoka Y, Mori K, Shimahara Y, Fukushima S, Mitsuyoshi K, Tanaka K, Kumada K, Ozawa K (1993) Hepatic vein reconstruction in pediatric living donor liver transplantation: An overview of a series of 30 cases. Transplant Proc 25:1098–1101

    PubMed  Google Scholar 

  57. Egawa H, Tanaka K, Uemoto S, Someda H, Moriyasu F, Sano K, Nishizawa F, Ozawa K (1993) Relief of hepatic vein stenosis by balloon angioplasty after living-related liver transplantation. Clin Transplant 7:306–311

    PubMed  Google Scholar 

  58. Tanaka K, Uemoto S, Tokunaga Y, Fujita S, Sano K, Nishizawa T, Sawada H, Shirahase I, Kim HJ, Yamaoka Y, Ozawa K (1993) Surgical techniques and innovations in living-related liver transplantation. Ann Surg 217:82–91

    PubMed  Google Scholar 

  59. Tokunaga Y, Tanaka K, Uemoto S, Tanaha A, Morimoto T, Mori K, Yamaoka Y Ozama K (1994) Experience with vascular grafts in living related liver transplantation Transplant Proc. 26:896–897

    PubMed  Google Scholar 

  60. Inomoto T, Nishizawa F, Terajima H, Shirakata Y, Yamamoto Y, Miyamoto S, Fujimoto M, Tanaka K, Yamaoka Y (1995) The use of the recipient's sigmoid artery for a revision of hepatic arterial reconstruction after thrombosis in LRLT. Transplantation 60:881–882

    PubMed  Google Scholar 

  61. Inomoto T, Nishizawa F, Sasaki H, Terajima H, Shirakata Y, Miyamoto S, Nagata I, Fujimoto M, Moriyasu F, Tanaka K, Yamaoka Y (1996) Experiences of 120 microsurgical reconstructions of hepatic artery in living-related liver transplantation. Surgery 119:20–26

    PubMed  Google Scholar 

  62. Uemoto S, Ozawa K. Tanaka K, Honda K, Mori K, Yamamoto E, Sano K, Fujita T, Shirahase I, Katoh H (1991) Experience with FK506 in living-related donor liver transplantation. Transplant. Proc 23:3007–3009

    PubMed  Google Scholar 

  63. Inomata Y, Tanaka K, Egawa H, Uemoto S, Ozaki N, Okajima H, Satomura K, Kiuchi T, Yamaoka Y, Hashida T. The evolution of immunosuppression with FK506 in pediatric living-related liver transplantation. Transplantation 61:247–252

  64. Yasuhara M, Hashida T, Toraguchi M (1995) Pharmacokinetics and pharmacodynamics of FK506 in pediatric patients receiving living-related donor liver transplantation. Transplant Proc 27:1108–1110

    PubMed  Google Scholar 

  65. Ramos HC, Reyes J, Abu Elmagd K, Zeevi A, Reinsmoen N, Tzakis A, Demetris AJ, Fung JJ, Flynn B, McMichael J (1995) Weaning of immunosuppression in long-term liver transplant recipients. Transplantation 59:212–217

    PubMed  Google Scholar 

  66. Hasegawa S, Tanak K, Egawa H, Inomata Y, Murakawa M, Terada Y, Arai T, Yamaoka Y, Mori K (1996) Perioperative respiratory management with fiberoptic bronchoscopy in pediatric living-related liver transplantation. Surgery 119:198–201

    PubMed  Google Scholar 

  67. Batts K (1996) Liver allograft rejection: Current status of classification and grading. Transplant Proc 28:453–456

    PubMed  Google Scholar 

  68. Sano K, Tanaka K, Uemoto S, Fujita S, Tokunaga Y, Inomata Y. Ozawa K, Minamishima Y (1994) Cytomegalovirus infection in living-related liver transplantation. Rapid diagnosis by human monoclonal antibody staining. Transplant Sci 4:105–111

    PubMed  Google Scholar 

  69. Egawa H, Ohishi T, Arai T, Matsui A, Inomata Y, Uemoto S, Okajima H, Kiuchi T, Tanaka K (1996) Application of in-situ hybridization technique (ISH) for quantitive assessment of ongoing Epstein-Barr virus (EBV) infection after living-related liver transplantation. In: Proceedings of the Am Soc Transplant Phys, Texas, USA

  70. Zaiko AB, Claus D, Clapuyt P, Esquival CO, Moulin D, Starzl TE, de Ville de Goyet J, Otte JB (1989) Obstruction to hepatic venous drainage after liver transplantation: Treatment with balloon angioplasty. Radiology 170:763–765

    PubMed  Google Scholar 

  71. Meister RK, Esquivel CO, Cox KL, et al (1993) The influence of portoenterostomy with stoma on morbidity in pediatric patients with biliary atreria undergoing orthotopic liver transplantation. J Pediatr Surg 28:389–390

    Google Scholar 

  72. Broelsch CE, Burdelski M, Rogiers X, Gundlach M, Knoefel WT, Langwieler T, Fischer L, Latta A, Hellwege H, Schults FJ, Schmiegel W, Sterneck M, Greten H, Kuechler T, Krupski G, Loeliger C, Kuehnl P, Pothmann W, Esch JS (1994) Living donor for liver transplantation. Hepatology 20:49S-55S

    PubMed  Google Scholar 

  73. Alonso ME, Piper BJ, Echols G, Thistlethwaite RJ, Whitington FP (1996) Allograft rejection in pediatric recipients of living-related liver transplantation. Hepatology 23:40–43

    PubMed  Google Scholar 

  74. Demetris AJ, Jaffe R, Tzakis A, Ramsey G, Todo S, Belle S, Esquivel C, Shapiro R, Markus B, Mroczek E (1988) Antibody-mediated rejection of human orthotopic liver allografts. A study of liver transplantation across ABO blood group barriers. Am J Pathol 132:489–502

    PubMed  Google Scholar 

  75. Guggenheim J, Samuel D, Reynes M, Bismuth H (1990) Liver transplantation across ABO blood group barriers. Lancet 336:519–523

    PubMed  Google Scholar 

  76. Bismuth H (1994) Consensus statement on indications for liver transplantation. Paris, June. Hepatology 20:1 63S-68S

    PubMed  Google Scholar 

  77. Farges O, Kalil AN, Samuel D, Saliba F, Arulnaden JL, Debat P, Bismuth A, Castaing D, Bismuth H (1995) The use of ABO-incompatible grafts in liver transplantation. A life-saving procedure in highly selected patients. Transplantation 59:1124–1133

    PubMed  Google Scholar 

  78. Cox K, Nakazato P, Berquist W, Concepcion W, Tokunage Y, Esquivel C (1991) Liver transplantation in infants of less than 10kg. Transplant Proc 23:1579–1580

    PubMed  Google Scholar 

  79. Renard TH, Andrews WS (1992) An approach to ABO-incompatible liver transplantation in children. Transplantation 53:116–121

    PubMed  Google Scholar 

  80. Yandzar T, Lambert T, Alvarez F, Gauthier F, Jacolot D, Huault G, Fabre M, Valauer J (1994) The outcome of ABO-incompatible liver transplantation in children with no specific alloantibodies at the time of transplantation. Transplantation 58:46–50

    PubMed  Google Scholar 

  81. Boudjema K, Cherqui D, Jaeck D, Chenard-Neu MP, Steib A, Freis G, Becmeur F, Brunot B, Simeoni U, Bellocq JP (1995) Auxiliary liver transplantation for fulminant and subfulminant hepatic failure. Transplantation 59:218–223

    PubMed  Google Scholar 

  82. Ichida T, Matsunami H, Kawasaki S, Makuuchi M, Harada T, Itoh S, Asakura H (1995) Living-related donor liver transplantation from adult to adult for primary biliary cirrhosis. Ann Intern Med 122:275–276

    PubMed  Google Scholar 

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  1. Department of Transplantation and Immunology, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, 606-01, Kyoto, Japan

    Koichi Tanaka & Yukihiro Inomata

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  1. Koichi Tanaka
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Tanaka, K., Inomata, Y. Present status and prospects of living-related liver transplantation. J Hep Bil Pancr Surg 4, 51–70 (1997). https://doi.org/10.1007/BF01211344

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