Outcome of Candidate Evaluation in Adult- To-Adult Living Donor Liver Transplantation in Japan: From the Coordinator's Point of View

Abstract

4 4 0 Supplement to Transplantation July 27, 2008, Volume 86 Number 2S match. Median follow-up duration was 28.0 months (0~93). And 56 recipients underwent one more acute rejection episodes. In univariate analysis, positive lymphocytotoxic cross-match was not signifi cant risk factor of acute rejection (p=0.625), while HCV (p=0.003), low MELD score (p=0.011), and no induction of anti-IL-2 receptor antibody (p=0.034) were revealed as risk factor for acute rejection. In multivariate analysis by Cox-Regression hazard model, younger recipient age (p=0.030, HR 0.965, CI 0.935~0.997), HCV (p=0.003, HR 0.268, CI 0.112~0.642), lower MELD score (p=0.006, HR 0.956, 0.926~0.987) were signifi cant risk factors. Conclusion: Positive lymphocytotoxic cross-match is not risk factor for acute cellular rejection. Purpose: In 2004, the Japanese National Insurance began to cover medical expenses for Adult-to-adult Living Donor Liver Transplantation (A2ALL) and the number of transplant candidates increased. However, not all candidates could receive A2ALL for a variety reasons. We report the outcome of candidates evaluated in one of the metropolitan university hospitals in Tokyo, Japan. This university is a major hospital with a special interest and experience in ABO blood type incompatible living donor liver transplants. Methods: The records of consecutive 170 candidates from 2003 to 2007 were reviewed and analyzed. Outcome: Of the 170 candidates (mean age=51.6,), 41 (24.1%) underwent A2ALL and 129 (75.9%) did not. The primary diagnoses established were Hepatitis B and/or C (108, 63.5%), alcoholic liver cirrhosis (20, 11.2%), fuluminant hepatitis (15, 0.9%). Seventy one candidates had HCC (71, 65.7%), beyond Milan criteria (52.1%). Of the 129 candidates, 107 were unsuitable for A2ALL, 15 went overseas and 7 went other Japanese hospitals to receive liver transplants. The main reasons identifi ed for those who did not receive A2ALL were 1) too late for transplant (46, 42.9%), 2) no donor (31, 28.9%), 3) other reasons such as considered social factors preferred deceased donor liver transplant (11, 10.2%). Conclusion: In Japan, only one-forth of candidates underwent A2ALL.Because of the diffi culty of fi nding a suitable living donor, about half cases were assessed too late for A2ALL. As a clinical transplant coordinator, facilitating meaningful communication among those patients and patients' family to make the right decision at the right time, it was very important to not miss the chance of a potentially life saving liver graft. An increase in organ donation from deceased donors in Japan is an urgent requirement.