ObjectiveTo evaluate the outcome of living related liver transplantation (LRLT) in adult patients and to assess graft size disparity and graft regeneration. Summary Background DataAlthough LRLT has been accepted as an optional life-saving procedure for pediatric patients with end-stage liver disease, the feasibility of LRLT for adult patients has not been reported with reference to a clinical series. MethodsAdult-to-adult LRLT was performed using whole left lobar grafts in 13 patients (5 with primary biliary cirrhosis, 6 with familial amyloid polyneuropathy, 1 with biliary atresia, and 1 with citrullinemia). The 13 donors comprised 5 husbands, 3 sons, 2 sisters, 2 fathers, and 1 mother. The ratio of the graft volume to standard liver volume (GV/SV ratio) was calculated for use as a parameter of graft size disparity. ResultsAlthough the liver graft was markedly small for size (GV/SV ratio 32%-59% at the time of LRLT), none of the 13 patients developed postoperative liver failure. Eleven of the patients are still alive and well with satisfactory graft function 2 to 35 months after LRLT. Graft liver volume increased rapidly after LRLT and approximated the standard liver volume with time. ConclusionsOur LRLT program for adult patients has produced good results. LRLT in adults can be indicated for selected donor-recipient combinations.Since Broelsch et al.' reported the first successful series in Western countries and also in Japan.2-8 The initial of living related liver transplantations (LRLTs), the use series of LRLTs reported by Broelsch et al. was limited of this innovative surgical treatment has steadily increased to infants with a body weight < 15 kg, and only the left lateral segment of the donor liver was used as a graft.

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AN INTERNATIONAL PANELIn contrast with other vascularized allografts, chronic liver allograft rejection is uncommon. Over the last two decades, the incidence at 5 years after transplantation has decreased from 15% to 20% in the 1980s to an expected incidence of 3% to 5% in current liver allograft recipients. 1 This is likely attributable to the unique immunologic properties of a liver allograft, better recognition and control of acute and the early phases of chronic rejection (CR), and the remarkable regenerative capabilities of the liver. 2-11 Nevertheless, CR is still an important cause of late liver allograft dysfunction and failure. 12-16 And from a practical perspective, proper recognition and staging of CR is essential for long-term patient management, because toxic side effects of long-term immunosuppression force clinicians to significantly lower or discontinue immunosuppression. 17-20 Moreover, given the inevitable decline in kidney and heart allograft structure and function because of CR, study of the relatively low incidence of CR in liver allografts, and the ability of the liver to recover from CR, will likely lead to valuable insights into transplantation immunobiology in general.In a previous consensus publication by the Banff Working Group, 21 the panel constructed a working schema for grading acute liver allograft rejection, which has subsequently proven to be simple, reliable, clinically relevant and scientifically correct. 22,23 It is used to grade the necroinflammatory activity of acute rejection that is potentially amenable to therapeutic intervention. At the 5th Banff Conference on Allograft Pathology in 1999, the main goal of the liver sessions was to identify the various stages in the evolution of CR, with the specific aim of addressing two main questions: (1) Can histopathologic features be identified at an early stage of CR, which if left untreated, are predictive of progression to graft failure? This has important clinical implications, because such cases may still be potentially reversible with the use of additional immunosuppression; and (2) Can histopathologic features be used to indicate that irreversible graft damage has occurred? This question also has obvious important clinical implications, because such cases are likely to be unresponsive to additional immunosuppression and depending on the complete clinicopathological profile, may require relisting for retransplantation. An important related issue is whether there are atypical patterns of chronic liver allograft rejection, which appear very similar or identical to chronic hepatitis and lead to cirrhosis, in contrast with the more commonly recognized pattern of CR. MATERIALS AND METHODSDuring the two years since the 4th Banff Consensus conference in 1997, investigators from several large programs and the NIDDK liver transplant database, studied various aspects of chronic liver allograft rejection, including clinical and demographic factors 11,24,25 and histopathologic findings associated with the evolution 26-28 and/or reversal o...

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