Patients in Japan who underwent living donor liver
transplantation (LDLT) for acute liver failure (ALF) were classified as
having excellent outcomes, with ten-year survival at 73%. The findings,
published in the September issue of Liver Transplantation,
a journal of the American Association for the Study of Liver Diseases
(AASLD), suggest that the type of liver disease or treatment plan does
not affect long-term patient survival following LDLT. Donor and patient
age, however, does impact long-term outcome post-transplant.
According to the AASLD, roughly 2,000 Americans develop ALF—formally called fulminant hepatitis—each
year, with many of these cases caused by acetaminophen (Tylenol)
overdose, drug-induced liver injury, autoimmune liver disease, or viral
hepatitis. Previous studies report patient survival from ALF was less
than 15% before the era of liver transplantation and significantly
better at more than 65% following transplantation.
LDLT—when a portion of a healthy liver from a
living donor is used for transplantation—was developed as an alternative
treatment option to overcome the shortage of deceased donor organs. A
2007 study by de Villa et al. found that LDLT accounts for less than 5%
of liver transplants in the U.S. and Europe compared to more than 90% in
Asia excluding mainland China.
“ALF is a rare, life-threatening condition where the
rapid deterioration of liver function causes changes in mental activity
and disrupts the body’s blood clotting capabilities,” explains lead
author Dr. Yasuhiko Sugawara, Associate Professor in the Graduate School
of Medicine at the University of Tokyo in Japan. “Expanding knowledge
of treatment options, such as LDLT, that improve patient outcome is
Using data from the Intractable Liver Disease Study
Group of Japan, researchers identified 209 ALF candidates who underwent
living donor liver transplantation.
The authors report that in patients who underwent LDLT the cumulative
one-year, five-year and ten-year survival rates following
transplantation were 79%, 74%, 73%, respectively. Patient age impacted
short-term and long-term mortality, while donor age only affected
long-term patient mortality.
“Our study demonstrates the benefit of LDLT in a
Japanese population, which has less access to deceased donor organs,”
concludes Dr. Sugawara. “Prospective studies are needed to determine
the overall impact of LDLT in all patients with ALF.”
In a related editorial also published in Liver Transplantation,
Professor Chung-Mau Lo with the University of Hong Kong and Queen Mary
Hospital in Hong Kong, China, notes that LDLT for ALF patients has
generated debate among experts in several areas: (1) reports in Western
countries of inferior outcome with LDLT in high-urgency situations; (2)
likelihood of ALF patients receiving a liver in countries with developed
deceased organ donation programs; and (3) concern with coercion of
donors and a possible increase of donor risk when the evaluation process
is rushed in such an urgent situation.
“Deceased donor liver transplantation is dictated by
the availability of the organ, and high-risk marginal grafts are
frequently used. LDLT allows for early transplant to avoid waitlist
mortality and better timing of the operation, which can be performed at
the first sign of patient deterioration,” concludes Professor Lo. “LDLT
for ALF has developed in Asia because there is no choice. Is it
possible that it may in fact be a better choice?”
This study and editorial are published in Liver Transplantation. Media wishing to receive a PDF of the articles may contact email@example.com.
Full citation: “Outcome after Living Donor
Liver Transplantation for Acute Liver Failure in Japan; Results of a
Nationwide Survey.” Noriyo Yamashiki, Yasuhiko Sugawara, Sumihito
Tamura, Nobuaki Nakayama, Makoto Oketani, Koji Umeshita, Shinji Uemoto,
Satoshi Moachida, Hirohito Tsubouchi and Norihiro Kokudol. Liver Transplantation; (DOI: 10.1002/lt.23469) Print Issue Date: September, 2012.
Editorial: “Living Donor Liver Transplantation for Acute Liver Failure: No Other Choice” Chung-Mau Lo. Liver Transplantation; (DOI: 10.1002/lt.23492) Print Issue Date: September, 2012.
Author Contact: To arrange an interview with
Dr. Sugawara please contact the Center for Liaison and Public Relations
in the University of Tokyo Hospital at firstname.lastname@example.org.
About the Journal:
Liver Transplantation is published by Wiley on behalf of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.
Since the first application of liver transplantation in a clinical
situation was reported more than twenty years ago, there has been a
great deal of growth in this field and more is anticipated. As an
official publication of the AASLD and the ILTS,
Liver Transplantation delivers current, peer-reviewed articles on
surgical techniques, clinical investigations and drug research — the
information necessary to keep abreast of this evolving specialty. For
more information, please visit http://wileyonlinelibrary.com/journal/livertransplantation.
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