Marcos A, Fisher R A, Ham J M, Olzinski A T, Shiffman M L, Sanyal A J, Luketic V A, Sterling R K, Olbrisch M E, Posner M P
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond 23219, USA.
Transplantation. 2000 Jun 15;69(11):2410-5. doi: 10.1097/00007890-200006150-00034.
The shortage of cadaveric livers has sparked an interest in adult-to-adult living donor transplantation. Right lobe donor hepatectomy is frequently required to obtain a graft of adequate size for adult recipients. Careful donor selection is necessary to minimize complications and assure a functional graft.
A four-step evaluation protocol was used for donor selection and satisfactory results of all tests in each step were required before proceeding to the next. Donors were selected based on a battery of laboratory studies chosen to exclude unrecognized infection, liver disease, metabolic disorders, and conditions representing undue surgical risk. Imaging studies included ultrasonography, angiography, magnetic resonance imaging, and intraoperative cholangiography and ultrasonography. The information obtained from liver biopsy was used to correct the estimated graft mass for the degree of steatosis.
From March 1998 to August 1999, 126 candidates were evaluated for living donation. A total of 35 underwent donor right lobectomy with no significant complications. Forty percent of all donors that came to surgery were genetically unrelated to the recipient. A total of 69% of those evaluated were excluded. ABO incompatibility was the primary reason for exclusion after the first step (71%) and the presence of steatosis yielding an inadequate estimated graft mass after the second step (20%).
Donor selection limits the application of living donor liver transplantation in the adult population. Unrelated individuals increase the size of the donor pool. Right lobe hepatectomy can be performed safely in healthy adult liver donors. Preoperative liver biopsy is an essential part of the evaluation protocol, particularly when the estimated graft mass is marginal.
尸体肝脏的短缺引发了对成人对成人活体供肝移植的兴趣。为获得足够大小的移植物以满足成人受者的需求，常常需要进行右叶供肝切除术。必须仔细选择供者，以尽量减少并发症并确保移植物功能正常。
采用四步评估方案进行供者选择，每一步所有检查结果均需令人满意方可进入下一步。根据一系列实验室检查来选择供者，这些检查旨在排除未被识别的感染、肝脏疾病、代谢紊乱以及代表过度手术风险的情况。影像学检查包括超声检查、血管造影、磁共振成像以及术中胆管造影和超声检查。从肝活检获得的信息用于根据脂肪变性程度校正估计的移植物质量。
1998年3月至1999年8月，对126名活体供肝候选者进行了评估。共有35例接受了供者右叶切除术，无明显并发症。所有接受手术的供者中有40%与受者无血缘关系。在接受评估的供者中，共有69%被排除。ABO血型不相容是第一步评估后被排除的主要原因（71%），而第二步评估后存在脂肪变性导致估计的移植物质量不足则是另一个原因（20%）。
供者选择限制了成人活体供肝移植的应用。非血缘个体增加了供者库的规模。在健康的成人供肝者中，右叶肝切除术可安全进行。术前肝活检是评估方案的重要组成部分，尤其是当估计的移植物质量处于临界状态时。
