Living donor liver transplantation for fulminant hepatic failure

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.