Liver transplantation in Japan: Registry by the Japanese Liver Transplantation Society

Abstract

As of 31 December 2017, a total of 9242 liver transplants have been carried out in 67 institutions in Japan. There were 447 deceased donor transplants (444 from heart‐beating donors and 3 from non‐heart‐beating donors) and 8795 living‐donor transplants. The annual total of liver transplants in 2017 was 416 (69 deceased donor transplants and 347 living‐donor transplants). The most frequent indication was cholestatic disease, followed by neoplastic disease and hepatocellular disease. In terms of hepatocellular disease in 2017, cirrhosis due to hepatitis C and B decreased (13 and 8, respectively), whereas alcoholic cirrhosis markedly increased (32). Patient survival following transplantation from heart‐beating donor (444 transplants: 1 year, 89.1%; 3 years, 85.2%; 5 years, 82.9%; 10 years, 75.4%; 15 years, 70.7%) was similar to that from living‐donor (8794 transplants: 1 year, 85.0%; 3 years, 80.9%; 5 years, 78.5%; 10 years, 73.2%; 15 years, 68.5%; 20 years, 65.7%; 25 years, 64.6%). Graft survival was very much the same as patient survival (heart‐beating donor: 1 year, 88.4%; 3 years, 84.5%; 5 years, 82.2%; 10 years, 74.7%; 15 years, 70.1%; living donor: 1 year, 84.3%; 3 years, 79.9%; 5 years, 77.3%; 10 years, 71.4%; 15 years, 66.3%; 20 years, 63.3%; 25 years, 61.9%). Survival data are reported according to age and sex of recipient, indication, age and sex of donor, ABO compatibility, and other factors.

“Real‐time” risk models of postoperative morbidity and mortality for liver transplants

“…DDLT and LDLT ratios are quite different in Japan versus in other countries. In the present study, similar to a previous report, LDLT was more common (89.6%) in the derivation cohort. However, mortality risk was similar among donor types ( P ‐value = 0.973, data not shown).…”

“…The new integrated database included all data from the NCD. The JLTS database included data on: primary diagnosis of the recipients; ABO blood type compatibility; re‐transplant (history of past LT); deceased/living donor; and graft volume . In the present study, we used data from the integrated database, which included the following: 13 categorical and 13 continuous preoperative variables; six continuous intraoperative variables (Table and Table ); and 27 categorical variables on postoperative morbidity (Table ) and mortality.…”

“…Specifically, data from the Scientific Registry of Transplant Recipients (SRTR) and the European Liver Transplant Registry (ELTR) showed 6‐month and 1‐year mortality rates of 10.6%‐12.0% and 12.7%‐18.0%, respectively. Additionally, data from the Japanese Liver Transplantation Society showed 1‐year mortality rates of 15.3% in 219 DDLT and 16.2% in 7255 LDLT between 1964 and 2013 . The Adult‐to‐Adult Living Donor Liver Transplantation Study (A2ALL) showed that, in the USA, the 90‐day and 1‐year mortality rates of LDLT were 13% and 19%, respectively, with morbidity rates of 82.8% for LDLT and 78.2% for DDLT .…”

“…In contrast, the Japanese Liver Transplantation Society (JLTS) accumulated precise demographic data of all LT recipients and living donors in Japan from 2012. The data included graft weight and ABO compatibility, which is information not included in the NCD database. However, as opposed to the NCD database, the JLTS database did not record postoperative morbidities.…”

Prognostic index consisting of early post‐transplant variables <2 weeks in adult living‐donor liver transplantation

“…Living‐donor liver transplantation (LDLT) has been recognized as a feasible alternative to deceased‐donor liver transplantation (DDLT) in the era of critical donor shortage, along with the remarkable progress of surgical techniques and patient care . Living‐donor liver transplantation provides comparable long‐term outcome to DDLT; however, compared with DDLT, partial liver grafts in LDLT always increase the risk of postoperative liver failure until they regenerate sufficiently . In fact, the high mortality and morbidity rates during the early postoperative period, especially within the first 6 months after adult LDLT, has long and widely been a common obstacle that needs to be addressed …”