Lacaille F, Belghiti J, Sauvat F, Michel J L, Farges O, Rengeval A, Sarnacki S, Sayegh N, Jan D, Revillon Y
Département de Pédiatrie, Hôpital des Enfants-Malades, Paris.
Gastroenterol Clin Biol. 1999 Jun-Jul;23(6-7):710-6.
Liver transplantation with living related donor has been recently developed to compensate for the insufficient number of liver grafts for children. The major problem is ethical because it implies voluntary mutilation of a healthy person. This paper report results in 37 living related donors.
Recipients were followed in Enfants-Malades Hospital. Investigations and donor surgery were performed at the Digestive Surgery Unit of Beaujon Hospital.
One donor was re-operated for bleeding, and another one a biliary fistula treated with percutaneous drainage for one week. The post-operative course was uneventful in the other donors, with a follow-up of between 2 and 50 months. Thirty-three children are alive (90%), one of them underwent a second transplant for arterial thrombosis. Vascular and infectious complications, and the number of rejection episodes were the same as in transplantations with a deceased donor. Biliary complications were frequent (15 patients out of 37) and significantly increased morbidity. A teenage boy who received a small graft (0.9% of his weight) presented initially with hepatic insufficiency without encephalopathy.
This technique has been shown to have a good balance between benefits and risks. Our experience confirms this, especially in very young children. Each case should be discussed individually and parental consent should be obtained without external pressure. Experience with this technique should be continued and at the same time the use of cadaveric grafts should be optimized.
最近开展了亲属活体供肝肝移植以弥补儿童肝移植供肝数量的不足。主要问题是伦理方面的，因为这意味着对健康人的自愿残害。本文报告了37例亲属活体供者的结果。
受者在儿童疾病医院接受随访。检查和供者手术在博若莱医院消化外科进行。
1例供者因出血再次手术，另1例胆瘘经皮引流治疗1周。其他供者术后过程顺利，随访2至50个月。33名儿童存活（90%），其中1例因动脉血栓形成接受了二次移植。血管和感染并发症以及排斥反应次数与尸体供肝移植相同。胆系并发症常见（37例中有15例），且显著增加了发病率。1名接受小体积移植物（占其体重0.9%）的青少年男孩最初出现肝功能不全但无肝性脑病。
已证明该技术在利弊之间有良好的平衡。我们的经验证实了这一点，尤其是在非常年幼的儿童中。每个病例都应单独讨论，应在无外界压力的情况下获得父母同意。应继续积累该技术的经验，同时优化尸体供肝的使用。
