Outcomes after living donor liver transplantation for acute liver failure in Japan: Results of a nationwide survey

Authors

  • Noriyo Yamashiki,

    1. Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
    2. Organ Transplantation Service, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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  • Yasuhiko Sugawara,

    Corresponding author
    1. Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
    2. Organ Transplantation Service, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
    • Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan 113-8655
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    • Telephone: 81-3-3815-5411; FAX: 81-3-5684-3989

  • Sumihito Tamura,

    1. Organ Transplantation Service, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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  • Nobuaki Nakayama,

    1. Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, Japan
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  • Makoto Oketani,

    1. Department of Digestive and Lifestyle-Related Disease, Graduate School of Medicine and Dental Sciences, Kagoshima University, Kagoshima, Japan
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  • Koji Umeshita,

    1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
    2. Japanese Liver Transplantation Society, Osaka, Japan
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  • Shinji Uemoto,

    1. Japanese Liver Transplantation Society, Osaka, Japan
    2. Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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  • Satoshi Mochida,

    1. Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, Japan
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  • Hirohito Tsubouchi,

    1. Department of Digestive and Lifestyle-Related Disease, Graduate School of Medicine and Dental Sciences, Kagoshima University, Kagoshima, Japan
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  • Norihiro Kokudo

    1. Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
    2. Organ Transplantation Service, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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  • This study was supported in part by grants-in-aid from the Japanese Ministry of Health, Labor, and Welfare to the Study Group of Intractable Hepatobiliary Diseases. Noriyo Yamashiki, Yasuhiko Sugawara, Sumihito Tamura, and Norihiro Kokudo were supported by a grant-in-aid for scientific research from the Japanese Ministry of Education, Culture, Sports, Science, and Technology and by grants-in-aid for research on human immunodeficiency virus/acquired immune deficiency syndrome and on measures for intractable diseases from the Japanese Ministry of Health, Labor, and Welfare.

  • See Editorial on Page 1005

Abstract

Nationwide surveys of acute liver failure (ALF) are conducted annually in Japan, and 20% of patients with ALF undergo liver transplantation (LT). We extracted data for 212 patients who underwent LT for ALF from the nationwide survey database of the Intractable Liver Diseases Study Group of Japan. After the exclusion of 3 patients who underwent deceased donor LT, 209 recipients of living donor liver transplantation (LDLT) were analyzed. ALF patients were placed into 3 subgroups according to the time from the onset of the disease to the occurrence of encephalopathy: patients who presented with encephalopathy within 10 days of the disease's onset were classified as having acute ALF, patients who presented within 11 to 56 days were classified as having subacute ALF, and patients who presented within 9 to 24 weeks were classified as having late-onset hepatic failure (LOHF). Long-term follow-up data were obtained from the registry of the Japanese Liver Transplantation Society. The 2 data sets were merged, and descriptive and survival data were analyzed. A Cox regression analysis was performed to define factors predicting overall mortality, short-term mortality (≤90 days after LT), and long-term mortality (>90 days after LT). One hundred ninety of the analyzed patients (91%) were adults (age ≥ 18 years); 70 patients (34%) were diagnosed with acute ALF, 124 (59%) were diagnosed with subacute ALF, and 15 (7%) were diagnosed with LOHF. Hepatitis B virus was the most common cause of acute ALF (61%), whereas autoimmune hepatitis (14%) and drug allergy–induced hepatitis (14%) were more frequent in patients with subacute ALF or LOHF. The cumulative patient survival rates 1, 5, and 10 years after LT were 79%, 74%, and 73%, respectively. Patient age was associated with short- and long-term mortality after LT, whereas ABO incompatibility affected short-term mortality, and donor age affected long-term mortality. In conclusion, the long-term outcomes of LDLT for ALF in this study were excellent, regardless of the etiology or classification. The majority of the donors were living donors. Increasing the deceased donor pool might be an urgent necessity. Liver Transpl, 2012. © 2012 AASLD.

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