Living Donor Liver Transplantation for Hepatitis B and C Cirrhosis

  • Yasuhiko Sugawara
  • Masatoshi Makuuchi
Conference paper


Recent advancements and results of living donor liver transplantation for viral hepatitis and cirrhosis are reviewed. Living donor liver transplantation has a significant advantage over cadaveric liver transplantation in hepatitis B virus - positive patients. The scheduled operation enables limited preoperative lamivudine administration, which reduces viral load without developing viral mutants. Subsequent indefinite hepatitis B immunoglobulin use in the postoperative period is a rational strategy for preventing viral re-infection. In contrast, preliminary results indicate that live liver donation might be disadvantageous for hepatitis C virus - positive patients. Preemptive antiviral therapy after transplantation might be necessary to overcome rapid viral recurrence and graft failure. Living donor liver transplantation is important for patients with cirrhosis due to viral hepatitis because of cadaveric organ shortage.


Liver Transplantation Live Donor Liver Transplantation Adefovir Dipivoxil Recurrent Hepatitis Standard Liver Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Strong RW, Lynch SV, Ong TH, Matsunami H, Koido Y, Balderson GA. Successful liver transplantation from a living donor to her son. N Engl J Med 1990;322:1505–1507.PubMedCrossRefGoogle Scholar
  2. 2.
    Tanaka K, Inomata Y. Present status and prospects of living-related liver trasnplantation. J Hep Bil Pancr Surg 1997;4:51–70.CrossRefGoogle Scholar
  3. 3.
    Hashikura Y, Makuuchi M, Kawasaki S, Matsunami H, Ikegami T, Nakazawa Y, Kiyosawa K, et al. Successful living-related partial liver transplantation to an adult patient. Lancet 1994;343:1233–1234.PubMedCrossRefGoogle Scholar
  4. 4.
    Cronin DC, Millis JM, Siegler M. Transplantation of liver grafts from living donors into adults - too much, too soon. N Engl J Med 2001;344:1633–1637.PubMedCrossRefGoogle Scholar
  5. 5.
    Sugawara Y, Makuuchi M, Takayama T, Imamura H, Dowaki S, Mizuta K, Kawarasaki H, et al. Small-for-size grafts in living-related liver transplantation. J Arn Coll Surg 2001;192:510–513.CrossRefGoogle Scholar
  6. 6.
    Surman OS. The ethics of partial-liver donation. N Engl J Med 2002;346:10–38.CrossRefGoogle Scholar
  7. 7.
    Sugawara Y, Makuuchi M, Imamura H, Kaneko J, Ohkubo T, Matsui Y, KokudoN.Living donor liver transplantation in adults: recent advances and results. Surgery 2002;132:348–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Kane MA. Global status of hepatitis B immunisation. Lancet 1996;348:696.PubMedCrossRefGoogle Scholar
  9. 9.
    Todo S, Demetris M, Van Thiel D, Teperman L, Fung JJ, Starzl TE. Orthotopic liver transplantation for patients with hepatitis B virus-related liver disease. Hepatology 1991;13:619–626.PubMedGoogle Scholar
  10. 10.
    Shouval D, Samuel D. Hepatitis B immune globulin to prevent hepatitis B virus graft reinfection following liver transplantation: a concise review. Hepatology 2000;32:1189–1195.PubMedCrossRefGoogle Scholar
  11. 11.
    Perrillo RP, Wright T, Rakela J, Levy G, Schiff E, Gish R, Martin P, et al. A multicenter United States-Canadian trial to assess lamivudine monotherapy before and after liver transplantation for chronic hepatitis B. Hepatology 2001;33:424–432.PubMedCrossRefGoogle Scholar
  12. 12.
    Seehofer D, Rayes N, Naumann U, Neuhaus R, Muller AR, Tullius SG, Berg T, et al. Preoperative antiviral treatment and postoperative prophylaxis in HBV-DNA positive patients undergoing liver transplantation. Transplantation 2001;72:1381–1385.PubMedCrossRefGoogle Scholar
  13. 13.
    Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996;334:693–639PubMedCrossRefGoogle Scholar
  14. 14.
    Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000;31;864–871.PubMedCrossRefGoogle Scholar
  15. 15.
    Sugawara Y, Makuuchi M, Takayama T, Imamura H, Kaneko J, Ohkubo T. Safe donor hepatectomy for living-related liver transplantation. Liver Transpl 2002;8:58–62.PubMedCrossRefGoogle Scholar
  16. 16.
    Urata K, Kawasaki S, Matsunami H, Hashikura Y, Ikegami T, Ishizone S, Momose Y, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology 1995;21:1317–1321.PubMedCrossRefGoogle Scholar
  17. 17.
    Lo CM, Cheung ST, Lai CL, Liu CL, Ng 1O, Yuen MF, Fan ST, et al. Liver transplantation in Asian patients with chronic hepatitis B using lamivudine prophylaxis. Ann Surg 2001;233:276–281, 21:276–281.Google Scholar
  18. 18.
    Malkan G, Cattral MS, Humar A, Al Asghar H, Greig PD, Hemming AW, Levy GA, et al. Lamivudine for hepatitis B in liver transplantation: a single-center experience. Transplantation 2000;69:1403–1407.PubMedCrossRefGoogle Scholar
  19. 19.
    Gilson RJ, Chopra KB, Newell AM, Murray-Lyon IM, Nelson MR, Rice SJ, Tedder RS, et al. A placebo-controlled phase VII study of adefovir dipivoxil in patients with chronic hepatitis B virus infection. J Viral Hepatol 1999;6:387–395.CrossRefGoogle Scholar
  20. 20.
    Perrillo R, Schiff E, Yoshida E, Statler A, Hirsch K, Wright T, Gutfreund K, et al. Adefovir dipivoxil for the treatment of lamivudine-resistant hepatitis B mutants. Hepatology 2000;32:129–134.PubMedCrossRefGoogle Scholar
  21. 21.
    Samuel D, Muller R, Alexander G, Fassati L, Ducot B, Benhamou JP, Bismuth H. Liver transplantation in European patients with the hepatitis B surface antigen. N Engl J Med 1993;329:1842–1847.PubMedCrossRefGoogle Scholar
  22. 22.
    Pruett TL, McGory R. Hepatitis B immune globulin: the US experience. Clin Transplant 2000;14 Supp12:7–13.Google Scholar
  23. 23.
    Sawyer RG, McGory RW, Gaffey MJ, McCullough CC, Shephard BL, Houlgrave CW, Ryan TS, et al. Improved clinical outcomes with liver transplantation for hepatitis B-induced chronic liver failure using passive immunization. Ann Surg 1998;227:841–850.PubMedCrossRefGoogle Scholar
  24. 24.
    McMahon G, Ehrlich PH, Moustafa ZA, McCarthy LA, Dottavio D, Tolpin MD, Nadler PI, et al. Genetic alterations in the gene encoding the major HBsAg: DNA and immunological analysis of recurrent HBsAg derived from monoclonal antibody-treated liver transplant patients. Hepatology 1992;15:757–766.PubMedCrossRefGoogle Scholar
  25. 25.
    Naoumov NV, Lopes AR, Burra P, Caccamo L, Iemmolo RM, de Man RA, Bassendine M, et al. Randomized trial of lamivudine versus hepatitis B immunoglobulin for long-term prophylaxis of hepatitis B recurrence after liver transplantation. J Hepatol 2001;34:888–894.PubMedCrossRefGoogle Scholar
  26. 26.
    EASL, EASL International Consensus Conference on Hepatitis C. Consensus statement. J Hepatol 1999;30:956–961.CrossRefGoogle Scholar
  27. 27.
    Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet 1997;349:825–832.PubMedCrossRefGoogle Scholar
  28. 28.
    Annual report of the US Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network Transplant Data: 1988–1994. Richmond, USA: United Network for Organ Sharing and the Division of Organ Transplantation, Bureau of Health Resources Development.Google Scholar
  29. 29.
    Gane EJ, Portmann BC, Naoumov NV, Smith HM, Underhill JA, Donaldson PT, Maertens G, et al. Long-term outcome of hepatitis C infection after liver transplantation. N Engl J Med 1996:334:815–820.PubMedCrossRefGoogle Scholar
  30. 30.
    Dickson RC, Caldwell SH, Ishitani MB, Lau JY, Driscoll CJ, Stevenson WC, McCullough CS, et al. Clinical and histologic patterns of early graft failure due to recurrent hepatitis C in four patients after liver transplantation. Transplantation 1996;61:701–705.PubMedCrossRefGoogle Scholar
  31. 31.
    Forman LM, Lewis JD, Berlin JA, Feldman HI, Lucey MR. The association between hepatitis C infection and survival after orthotopic liver transplantation. Gastroenterology 2002;122:889–896.PubMedCrossRefGoogle Scholar
  32. 32.
    Gane EJ, Portmann BC, Naoumov NV, Smith HM, Underhill JA, Donaldson PT, Maertens G, et al. Long-term outcome of hepatitis C infection after liver transplantation. N Engl J Med 1996;334:815–820.PubMedCrossRefGoogle Scholar
  33. 33.
    Manez R, Mateo R, Tabasco J, Kusne S, Starzl TE, Duquesnoy RJ. The influence of HLA donor-recipient compatibility on the recurrence of HBV and HCV hepatitis after liver transplantation. Transplantation 1995;59:640–642.PubMedGoogle Scholar
  34. 34.
    Gretch D, Wile M, Gaur L. Donor-recipient match at the HLA-DQB locus is associated with recrudescence of chronic hepatitis following liver transplantation for end stage hepatitis C. Hepatology 1993;18Supp1:108A.CrossRefGoogle Scholar
  35. 35.
    Sheiner PA, Boros P, Klion FM, Thung SN, Schluger LK, Lau JY, Mor E, et al. The efficacy of prophylactic interferon alfa-2b in preventing recurrent hepatitis C after liver transplantation. Hepatology 1998;28:831–838.PubMedCrossRefGoogle Scholar
  36. 36.
    Singh N, Gayowski T, Wannstedt CF, Shakil AO, Wagener MM, Fung JJ, Marino IR. Interferon-alpha for prophylaxis of recurrent viral hepatitis C in liver transplant recipients: a prospective, randomized, controlled trial. Transplantation 1998;65:82–86.PubMedCrossRefGoogle Scholar
  37. 37.
    Mazzaferro V, Tagger A, Schiavo M, Regalia E, Pulvirenti A, Ribero ML, Coppa J, et al. Prevention of recurrent hepatitis C after liver transplantation with early interferon and ribavirin treatment. Transplant Proc 2001;33:1355–1357.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2004

Authors and Affiliations

  • Yasuhiko Sugawara
    • 1
  • Masatoshi Makuuchi
    • 1
  1. 1.Department of SurgeryGraduate School of Medicine, University of TokyoTokyoJapan

Personalised recommendations