LiverHepato-Gastroenterology 2011; 58:1-6 H.G.E. Update Medical Publishing S.A., Athens-StuttgartA Single Institution Experience with Living Donor Liver Transplantation for Acute-on-chronic Hepatitis B Liver FailureBackground/Aims: This study reports our pre- liminary experience of living donor liver transplan- tation (LDLT) for patients with acute-on-chronic liver failure (AoCLF) caused by hepatitis B. Methodology: 47 patients who demonstrated Ao- CLF caused by hepatitis B with mean (SD) Mod- el for End-Stage Liver Disease scores of 39.25.1 were divided by the transplantation group (n=19) and the non-transplantation group (n=28) accord- ing to whether or not undergoing LDLT. At the same time, 30 hepatitis B cirrhosis recipients who underwent LDLT and did not reach the criteria of AoCLF were selected as the control group (n=30). In the transplantation group, veno-venous by- pass, molecular adsorbent recirculating system (MARS) and continuous renal replacement ther- apy (CRRT) were introduced. The intraoperative data, post-transplant complications and mortality were analyzed retrospectively. Results: There were no significant differences in survival rates of 1, 6 and 12 months and the postoperative complications except for pneumo- nia and diabetes, between the control group and the transplantation group (p0.05). Recurrence of hepatitis B was not found in the recipients of the control group and the transplantation group. Conclusion: Right-lobe LDLT may be an effec- tive therapeutic option for patients with acute-on- chronic hepatitis B liver failure.ABSTRACTINTRODUCTIONIn the USA, the most frequent underlying cause for acute-on-chronic liver failure (AoCLF) is irre- versible liver damage due to chronic alcohol abuse, followed by viral hepatitis and autoimmune disor- ders (1), but in China, type B hepatitis is the most common cause (2). Despite recent technological advances AoCLF remains a clinical condition as- sociated with high mortality unless urgent ortho- topic liver transplantation (OLT) is performed on time, which is due to acute decompensation of liver function in patients with chronic pre-existing liver diseases (3,4). The shortage of cadaveric livers has sparked an interest in adult-to-adult living donor liver transplantation (LDLT). LDLT with right lobe grafts has dramatically increased with the increas- ing success rates and lower donor morbidities (5,6). At present, right-lobe LDLT is adopted as one of the solutions to overcome the graft shortage in adult patients waiting for liver transplantation (5,6). The survival results of patients demonstrating AoCLF and undergoing LDLT have been reported to be poor (7). However, in our center, a better result of LDLT for patients with AoCLF has been achieved. There- fore, our preliminary experience of LDLT treatment for AoCLF is reported in this manuscript.METHODOLOGY From January 2002 to November 2007, 138 LD- LTs, including 12 pediatric (less than 18 years of age) and 126 adult cases were performed in West China Hospital, Sichuan University. The 126 adult- to-adult LDLTs consisted of 125 cases using right lobe graft without middle hepatic vein (MHV), and 7 cases using dual grafts (1 case using 2 left lobes, 6 using 1 right lobe without MHV and 1 left lobe). The most common indications for adult-to-adult LDLT in our center were liver cirrhosis caused by hepatitis B virus, primary liver cancer. The selec- tion criteria for AoCLF caused by hepatitis B in this group were: chronic pre-existing hepatitis B, serum bilirubin 280mol/L (20mg/dL) and/or hepatic en- cephalopathy grade 2 (8,9). According to the above criteria, 19 recipients who underwent LDLT and accorded with acute-on-Zheyu Chen1, TianFu Wen1, Yong Zeng1, Lichun Wang2, Jia jie Lu2, Shu Gong1, Hong Tan2, Ping Feng2, Bo Li1, JiChun Zhao1, WenTao Wang1, MingQing Xu1, Jiayin Yang1, Hong Wu1 and LuNan Yan11Liver Transplantation Center and Hepato-Bilio-Pancreatology Department, West China Hospital, West China Medical School of Sichuan University, Chengdu, China 2Infectious Disease Center, West China Medical School of Sichuan University, Chengdu, ChinaCorresponding author: LuNan Yan, Liver Transplantation Center and Hepato-Bilio-Pancreatology Department, West China Hospital, West China Medical School of Sichuan University, Chengdu, 610041, China E-mail: yanlunan688163.comKEY WORDS: Acute-on-chronic liver failure; Mo- lecular adsorbent re-circulating system; Living donor liver trans- plantation; Continuous renal replacement therapyHepato-Gastroenterology 58 (0)Z Chen, T Wen, Y Zeng, et al.chronic hepatitis B liver failure were selected as the transplantation group in this manuscript. The 28 recipients who did not undergo LDLT owing to the shortage of donors and registered in our center and accorded with acute-on-chronic hepatitis B liver failure were selected as the non-transplantation group. At the same time, 30 hepatitis