Inomata Y
Department of Transplantation and Immunology, Kyoto University, Japan.
Nihon Geka Gakkai Zasshi. 1996 Nov;97(11):978-83.
Living related liver transplantation (LPLT) as well as reduced sized graft or split liver transplantation has come from the situation with donor shortage for conventional whole liver transplantation from brain dead donors (cadaveric liver transplantation; CLT). To date, about fifty thousands liver transplants have been undergone all over the world. CLT has much diversity of the original diseases, but mainly liver cirrhosis in adults and biliary atresia in children. Original diseases for LRLT have been deviated to cholestatic diseases in childhood, but now LRLT for adults and other diseases in children, i.e. fulminant hepatitis and metabolic disorders, are increasing. The survival rate of LRLT in Kyoto University for first 230 consecutive cases was 79.5%. The main cause of death was infection-related events. There are several problems in LRLT to be resolved; perioperative management of infectious complications, how to deal with the unavoidable ABO incompatible matching transplants, how to expand the national capacity of LRLT to respond the urgent transplantations. Earlier establishment of CLT program in Japan will be necessary to make the liver transplantation the beneficial procedure for more people with end stage liver diseases.
亲属活体肝移植（LPLT）以及减体积肝移植或劈离式肝移植源于脑死亡供体常规全肝移植（尸体肝移植；CLT）供体短缺的情况。迄今为止，全世界已进行了约5万例肝移植。CLT的原发病种类繁多，但主要是成人肝硬化和儿童胆道闭锁。LRLT的原发病已偏向儿童期胆汁淤积性疾病，但目前成人LRLT以及儿童的其他疾病，即暴发性肝炎和代谢紊乱，正在增加。京都大学连续230例LRLT的生存率为79.5%。主要死亡原因是感染相关事件。LRLT有几个问题有待解决；感染并发症的围手术期管理、如何处理不可避免的ABO血型不相容配对移植、如何扩大国家LRLT能力以应对紧急移植。日本有必要尽早建立CLT项目，以使肝移植成为更多终末期肝病患者的有益治疗手段。
