Background. Living donor liver transplantation (LDLT) was originally indica
ted only for elective cases of pediatric patients with end-stage liver dise
ase. In Japan, however, where liver transplantation from brain-dead donor i
s performed very rarely, this indication has been expanded to emergency cas
es such as fulminant hepatic failure (FHF).
Methods. Thirty-eight patients with FHF were treated between May 1992 and A
pril 1999, Causes of acute liver failure were non-A, non-B hepatitis in 27
patients, hepatitis B virus in seven, and hepatitis A virus, Epstein-Barr v
irus, herpes simplex virus, and chrome poisoning in one each.
Results. Four patients did not undergo LDLT because of severe brain damage
or combined multiple organ failure, The remaining 34 patients underwent a t
otal of 36 LDLTs, including two retransplantations; 16 children received tr
ansplants of 17 lateral segments, three children and eight adults transplan
ts of 11 left lobes, and seven adults transplants of eight right lobes, A t
otal of 15 recipients died, four of primary graft dysfunction, three of ref
ractory acute rejection, two of pneumonia, and one each of ductopenic rejec
tion, sepsis, aplastic anemis, recurrence of Epstein-Barr virus hepatitis,
multiple organ failure by chrome poisoning, and unknown hepatic failure, Pr
imary graft dysfunction developed in adult recipients with small-for-size g
raft transplants, whereas refractory acute rejection and ductopenic rejecti
on occurred in six grafts each of children with non-A, non-B FHF.
Conclusions. LDLT can be safely expanded to cases of FHF in adult patients.
Primary graft dysfunction in adult recipients with small-for-size left lob
e grafts can be overcome by using right lobes, However, refractory acute re
jection and ductopenic rejection in children remain a major problem.