演題

IS-3-4

Advances in living donor liver transplantation in the last 20 years in Keio University

[演者] 篠田 昌宏:1
[著者] 板野 理:1, 尾原 秀明:1, 北郷 実:1, 日比 泰造:1, 阿部 雄太:1, 八木 洋:1, 松原 健太郎:1, 山田 洋平:1, 藤野 明浩:1, 星野 健:1, 黒田 達夫:1, 北川 雄光:1
1:慶應義塾大学外科

Background: More than 20 years has passed since the initiation of living donor liver transplantation (LDLT) program in Japan. We have performed 222 cases (129 adult and 93 pediatric cases) of LDLT for the last 20 years and developed some advances for recipients and donors. Patients and methods: One of the most important advances is an immunosuppressive protocol for adult ABO blood type incompatible (ABOI) cases. Intra-portal infusion therapy and rituximab administration are mainly employed for adult ABOI LDLT. Another important advance is patient selection criteria. Based on a multivariate analysis for the past cases, we are carefully selecting donor and recipient. As for donor, reduced incision operation has also been developed introducing video or laparoscopy assisting.Results: A total of 29 cases of adult ABOI LDLT was performed. Despite of significantly higher incidences of postoperative complications in ABOI cases, there was no significant difference of 5-year survival rate between the groups of non-ABOI (77%, n=100) and ABOI (70%, n=29). Three emergent ABOI cases are surviving uneventfully for long term. A multivariate analysis revealed that high age donor and small for size graft were significant prognostic factors for the recipient survival. We greatly mind the combination of the 2 factors for patient selection. Reduced incision donor hepatectomy has been performed in 39 cases and the outcomes are comparable or superior to standard incision operation.Conclusion: The number of deceased donor liver transplantation remains limited in Japan. It is still very important to expand LDLT safely developing advances like above.
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