肝移植−最近の進歩

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（特に重要な文献については，番号をゴシック体で表記している．）

44

Recent Advances in Liver Transplantation

Tomoharu YOSHIZUMI

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University

Abstract

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.

Key words : liver transplantation, small-for-size graft syndrome, Rejection, Rituximab, Hepatitis B

virus

著者プロフィール

吉住 朋晴（よしずみ ともはる）

九州大学教授（大学院医学研究院消化器・総合外科学）．医学博士

◆略歴 1967 年熊本県生まれ．1992 年九州大学医学部卒業．2000 年医学博士取得．2003 年九州大

学病院第二外科助手．2006 年徳島大学病院消化器・移植外科講師．2008 年済生会福岡総合

病院外科部長．2012 年九州大学病院肝臓・脾臓・門脈・肝臓移植外科講師．2016 年九州大

学大学院消化器・総合外科准教授．2022 年より現職．

◆研究テーマと抱負 肝移植における手術手技の確立，グラフト機能，免疫抑制剤の使用法，肝細胞

癌の治療戦略を研究テーマとしている．世界に羽ばたく外科医を一人でも多く育成したい．

◆趣味 サッカー（現在は観戦のみ）

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