Living related liver transplantation.

The introduction of cyclosporine was a major advance in liver transplantation, leading to increased numbers of liver transplant cases and, at the same time, a relative shortage of available donor organs. As one of the modalities to decrease the mortality rate on the waiting list, living related liver transplantation (LRLT) was initiated. In the LRLT program of Kyoto University, which started in June 1990, the number of cases has increased yearly as its application expanded from pediatric to adult patients. A landmark in LRLT was the introduction of right lobe grafts, which have become a standard procedure in adult-to-adult living donor liver transplantation. The basic immunosuppressive regimen consisted of tacrolimus and low-dose steroids from the beginning of our LRLT program. However, since documentation of significant improvements in clinical efficacy with Neoral compared to Sandimmun-based immunosuppression, the role of cyclosporine in LRLT is now being reevaluated.