J.Jpn. Surg. Soc.. 121(2): 169-176, 2020

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Feature topic

LIVER TRANSPLANTATION

In Japan, 400-450 liver transplantations (LTs) are performed annually, and more than 80% of them rely on living-donor liver grafts. Since the first case in 1989, living-donor LT has been established as a radical treatment for liver failure and has achieved outcomes equivalent to deceased-donor LT. In the meantime, the number of deceased-donor LTs has remained at around 60 cases annually even after the revised Organ Transplant Law was enacted in 2010. As a recent topic, the recipient selection criteria for deceased-donor LT was revised on May 15, 2019. Registration to receive a donor graft is generally possible with a Child-Pugh score of 10 or more, and after registration, the Model for End-stage Liver Disease score is reflected in the ranking on the recipient waiting list. Additionally, the transplant indications for hepatocellular carcinoma patients have been expanded from the existing Milan criteria to the 5-5-500 rule. In this way, LT in Japan has changed over the past 30 years. Even though early posttransplant outcomes have improved over time, the long-term results have not changed markedly. In addition to continuous evaluation of the transplanted liver, the treatment of co-morbidities such as hypertension, diabetes, and hyperlipidemia, renal protection by reducing the dosages of immunosuppressive drugs, and screening for de novo malignant tumors are essential.

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