Requirements for the establishment of cadaveric liver transplantation in Japan

We report our experience with patient registration and care, and describe requirements for establishing a cadaveric liver transplantation protram in Japan. Since June 1991, 26 candidates have been evaluated for liver transplants (LTx) in our program. Of these, five patients had one or two concomitant hepatocellular carcinomas (HCCs) 1-2.5 cm in diameter, for which four were treated by ethanol injection. Five patients died waiting, and three underwent LTx abroad, while another received an ABO incompatible LTx from a non-heart beating donor in our program and died of multi-organ failure. Another patient lost candidacy for resuming drinking, leaving three waiting. Donor referral remains rare in Japan, where we encourage early patient registration in anticipation of long waiting, and now exclude malignancies other than a solitary HCC less than 2 cm, complicating non-B and Child C cirrhosis. Other requirements for a cadaveric liver transplant program were detailed.