No abstract

Graft-versus-host disease (GVHD) is an uncommon but potentially devastating complication following liver transplantation. Recently, it was shown that use of a human leukocyte antigen (HLA)-homozygous donor leading to one-way HLA matching significantly increases the risk of GVHD after living donor liver transplantation (LDLT). However, the precise impact of HLA matching between donor and recipient on the risk of GVHD is not yet clear. We surveyed instances of fatal GVHD following LDLT in Japan and reviewed all 8 cases in detail, especially with respect to HLA matching. Serological typing showed that 7 of those cases had donor-dominant one-way HLA matching in the 3 loci of HLA-A, -B, and -DR, while one had donor-dominant one-way HLA matching in the 2 loci of HLA-A and -DR and identical alleles in the B locus. However, DNA typing revealed that the latter case had 1-way HLA matching in the 3 loci. Further, we analyzed HLA typing of 906 donor-recipient pairs who underwent LDLT. There were 5 cases with donor-dominant one-way matching in 2 loci and 2 with donor-dominant one-way matching in 1 locus. All of those cases except 1, who died from an unrelated cause, are alive without an obvious presentation of GVHD. In conclusion, our results suggest that the total number of loci with donor-dominant one-way HLA matching is important for determining the risk of fatal GVHD following LDLT, and that DNA typing of HLA alleles is indispensable in some cases to identify the true risk of donor-dominant 1-way HLA matching. Graft-vs.-host disease (GVHD) is an uncommon but devastating complication following liver transplantation that results from the engraftment of T lymphocytes associated with the liver graft. It is characterized by fever, skin rash, diarrhea, or pancytopenia, which usually occurs 2 to 6 weeks after the procedure. 1-3 One-way matching between a human leukocyte antigen (HLA)-homozygous donor and a haploidentical recipient is a recognized risk factor for GVHD after transplantation. 4,5 Although such a combination of donor and recipient HLA is extremely rare in case of cadaver donor liver transplantation, complete donor-dominant 1-way HLA matching between donor and recipient is a realistic possibility in living donor liver transplantation (LDLT) cases, because most of those donors are genetically related to the respective recipients. Recently, it was shown that use of an HLA-homozygous donor resulting in donor-dominant one-way HLA matching significantly increases the risk of developing GVHD after LDLT, and some have insisted that such donors should be completely excluded. 6,7 However, the precise impact of HLA matching between donor and recipient on the incidence of GVHD has not been clarified. In the present study, we reviewed all reported cases of fatal GVHD after LDLT in Japan and focused on the number of loci with HLA matching between donor and recipient. PATIENTS AND METHODSIn this retrospective study, we investigated the incidence of fatal GVHD following LDLT in Japan at the time of writing and reviewed all the cas...

Mild macrovesicular steatosis may be related to adverse outcome in living liver donors who undergo right hepatectomy and, in terms of donor safety, is of potential concern in donor selection.

Recipient HBV status seems to be the most important factor affecting success of HBV vaccine after liver transplantation. In non-HBV patients who received grafts from HBcAb-positive donors, HBV vaccination is an effective, cost-saving, and safe method for prevention of HBV reactivations. In contrast in chronic HBV patients, response rate was quite poor, so some modifications such as combination with adjuvant or modification of administration schedules should be considered.