肝移植−最近の進歩

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タイトル別名
  • Recent Advances in Liver Transplantation
  • 肝移植 : 最近の進歩
  • カン イショク : サイキン ノ シンポ

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説明

Liver transplantation (LT) is an established treatment for end-stage liver disease worldwide. Living donor LT (LDLT) has increased because of the disparity between the demand and supply of deceased donor organs in Japan. As of 2021, 10,836 LTs had been performed in Japan. There were 715 deceased donor transplants and 10,121 LDLTs. The most frequent indication for LT was cholestatic disease followed by hepatocellular disease and neoplastic disease. Alcoholic cirrhosis and non-alcoholic steatohepatitis have increased as an indication for LT. Graft outcomes after LDLT have significantly improved because of progress in surgical techniques and immunosuppression. Five-year patient survival after primary LT from a heart-beating donor was 83.1％, whereas that following primary LDLT was 74.7％. A right lobe graft is considered to have a better outcome compared with that of other parts of the liver. However, donor safety must be considered and unnecessary surgery should be avoided for healthy living donors. Attempts, including simultaneous splenectomy, have been made to control excessive portal flow to a small-for-size liver graft. Rituximab was introduced to prevent antibody-mediated rejection, which has a high rate of bile duct and vascular complications after ABO incompatible LDLT. Hepatitis B/C virus recurrence can be controlled using an organized treatment strategy. The Japanese Liver Transplantation Society has established new LT indication criteria for hepatocellular carcinoma patients, which are called the Japan criteria. Donation after cardiac death and machine perfusion may be future possibilities to expand the donor pool. We herein review the literature and assess our current knowledge and strategies for LDLT.

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