We read with interest the article by Campsen et al. 1 describing the outcomes of adult-to-adult living donor liver transplantation (LDLT) for acute liver failure (ALF) in the United States. They described 2 concerns in applying LDLT for ALF: appropriate donor evaluation during the rapid evolution of ALF and the outcome of the critically ill recipients receiving a partial graft. Because we have reported the largest adult-toadult LDLT series in the literature, 2 comments on their report with an update of our series are herein described.
Up to September 2007, 47 LDLTs (16%) were performed for ALF among 294 LDLTs at Kyushu University Hospital. Among them, 44 cases were adult-to-adult LDLTs for ALF, including16 males and 28 females, who ranged in age from 18 to 47 years (mean, 45 ฯฎ 12 years). The majority of the patients (n ฯญ 32, 73%) received left-lobe LDLT. Because the opportunity to perform deceased donor liver transplantation is almost not an option in Japan, possible donor candidates were transferred with an ALF patient to our center and underwent donor evaluation, including a history and physical, blood work, sonogram, and computed tomography volumetry, on the day of arrival. 2,3 There was no donor mortality in our series. Nonliver-associated complications occurred in 12 donors (23%), including peptic ulcer (n ฯญ 2), gastric stasis (n ฯญ 3), wound problem (n ฯญ 3), alopecia (n ฯญ 1), and temporary ulnar nerve palsy (n ฯญ 1). Liver-associated complications occurred in 5 donors (11%), including biliary problems (n ฯญ 3) and hyperbilirubinemia (n ฯญ 2). The donor complication rate in ALF (34%) was the same as that in patients with other indications (34%), and the evaluation process, carried out within a short period, did not cause any significant harm to the patients. 4 Despite such acceptable outcomes, we need to mention that a recent LDLT case for ALF turned out to have small-cell esophageal cancer, which was diagnosed by screening endoscopy 1 month after LDLT. The patient thereafter died of multiple systemic cancer dissemination 1 year after LDLT. The patient was a 61-year-old