In 1993, the Shinshu Group performed the first successful adult-to-adult living donor liver transplantation (LDLT). During the first 10 years of LDLT, many technical innovations have been reported. The major limitation of LDLT for adult recipients is the size of the graft. To overcome the problem, several graft types were designed, including left liver graft with caudate lobe, right liver, modified right liver, and right lateral sector and dual grafts. The necessity and criteria of reconstruction of middle hepatic vein is still on debate in right liver graft without trunk of middle hepatic vein. Biliary reconstruction remains a significant source of morbidity in LDLT. Donor safety must always be the primary consideration in LDLT and the selection criteria and management of the living donor must continue to be refined. On February 21, 2004, the 10 th anniversary of the adult-to-adult LDLT meeting was held in Tokyo to review the accumulated experience and the presented information is summarized. (Liver Transpl 2004;10:715-720.)
L iving donor liver transplantation (LDLT) was first introduced among the pediatric population in 1989,1 and the first successful case in the total occurred in 1990. 2 On November 2, 1993, the Shinshu Group performed the first successful adult-to-adult LDLT. 3 The patient, who was a 53-year-old woman with primary biliary cirrhosis, received a left liver graft from her son. The number of LDLT procedures for adult patients has increased rapidly since then. By June 2002, there were 433 adult LDLT cases recorded in the European Liver Transplantation Registry 4 with 3-year graft and patient survival rates of 65% and 68%, respectively.
According to the United Network for Organ Sharing, 5 731 adult LDLT cases had been performed in the United States by October 2001. The 3-year graft survival was 47% between 1998 and 1999 (n Ο156), but it improved significantly to 61% between July 1999 and June 2000 (n Ο 285). According to the Japanese Liver Transplantation Society, 6 1063 adult LDLT procedures were performed in Japan by the end of 2002. All of the donors were related to the patients; most of them were within the third degree of consanguinity. During the same period, only 10 adult patients underwent liver transplantation using grafts from deceased donors.