Amersi F, Farmer D G, Busuttil R W
Department of Surgery, Liver and Pancreas Transplantation, University of California, Los Angeles, USA.
Clin Transpl. 1998:255-61.
In the past 6 years, advances in surgical technique and immunosuppression regimens have improved overall survival of transplant patients. Hepatitis C and alcoholic cirrhosis are the most common indications for transplantation at this center in the adult population while biliary atresia remains the most common indication in children. Organ shortages remain the most formidable obstacle to widespread application of organ transplantation. As recipient indications and criteria for transplantation expand, the number of patients awaiting organs increases. Simultaneously, donor criteria has not expanded and overall donor numbers have not increased substantially. We have used several approaches to alleviate the shortage of organs for both adults and children. Living-related donor transplantation yields excellent results and the operation can be done in an elective setting; however, it places an otherwise healthy person at risk. It is justified on basis of good results and the present shortage of organs. In-situ split-liver transplantation presents the opportunity to transplant children with size-matched organs without reducing the adult cadaveric pool. It is limited by the technical expertise required to perform the procedure safely. It can reduce the need to resort to living donor transplantation and is routinely used as the first option for pediatric patients awaiting transplantation at UCLA. Our results show that good results can be achieved with strict donor and recipient selection. In situ splitting has had a substantial impact on decreasing the pediatric waiting list time at our institution. Small bowel transplantation results have been improving; however, the complications related to the heavy immunosuppressive regimens need to be resolved.
在过去6年里，手术技术和免疫抑制方案的进步提高了移植患者的总体生存率。丙型肝炎和酒精性肝硬化是该中心成年人群中最常见的移植适应证，而胆道闭锁仍是儿童中最常见的适应证。器官短缺仍然是器官移植广泛应用的最巨大障碍。随着移植受者适应证和标准的扩大，等待器官的患者数量增加。同时，供体标准并未扩大，供体总数也没有大幅增加。我们采用了几种方法来缓解成人和儿童的器官短缺问题。亲属活体供体移植效果极佳，手术可在择期情况下进行；然而，这会使一个原本健康的人面临风险。鉴于良好的效果和目前器官短缺的情况，这样做是合理的。原位劈离式肝移植为儿童移植大小匹配的器官提供了机会，同时又不减少成人尸体供肝库。它受到安全实施该手术所需技术专长的限制。它可以减少诉诸亲属活体供体移植的必要性，并且在加州大学洛杉矶分校，它通常被用作等待移植的儿科患者的首选方案。我们的结果表明，通过严格的供体和受体选择可以取得良好的效果。原位劈离对缩短我们机构儿科患者的等待名单时间产生了重大影响。小肠移植的结果一直在改善；然而，与强效免疫抑制方案相关的并发症需要解决。
