Soejima Yuji, Sugimachi Keizo
Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Nihon Geka Gakkai Zasshi. 2002 May;103(5):423-7.
Because the shortage of donor livers has been the rate-limiting factor in the expansion of liver transplantation, several innovative techniques including reduced, split, and living donor liver transplantation have been developed to expand the relatively constant pool of organs. Domino liver transplantation, which was first reported from Portugal in 1995, has been performed worldwide and allows a donor organ to be used for a subsequent graft in a second liver recipient. Domino liver transplantation involves specific ethical and technical problems. The most important ethical problem in the procedure is the use of a diseased liver (e.g., familial amyloid polyneuropathy [FAP]) for a second recipient. Furthermore, the safety of the first recipient (FAP patient) should be the primary consideration. From the technical point of view, the management of short vascular cuffs is important, especially in domino liver transplantation from a living donor. The results of split liver transplantation have significantly improved and it is now recognized as an ideal method to expand the donor pool, especially for small children. Either the ex vivo or in vivo technique can be used with comparable results.
由于供肝短缺一直是肝移植扩大规模的限制因素，因此人们开发了几种创新技术，包括减体积肝移植、劈离式肝移植和活体供肝移植，以扩大相对固定的器官库。多米诺肝移植于1995年首次在葡萄牙报道，现已在全球范围内开展，它能使一个供体器官用于第二位肝受体的后续移植。多米诺肝移植涉及特定的伦理和技术问题。该手术中最重要的伦理问题是将患病肝脏（如家族性淀粉样多神经病[FAP]）用于第二位受体。此外，第一位受体（FAP患者）的安全应是首要考虑因素。从技术角度来看，短血管袖套的处理很重要，尤其是在活体供体的多米诺肝移植中。劈离式肝移植的效果有了显著改善，现在它被认为是扩大供体库的理想方法，尤其是对于小儿患者。体外或体内技术均可使用，效果相当。
