Renz John F, Yersiz Hasan, Farmer Douglas G, Hisatake Garrett M, Ghobrial R Mark, Busuttil Ronald W
Dumont-UCLA Transplantation Center, Room 77-120 CHS, 10833 Le Conte Ave., Los Angeles, CA 90095, USA.
J Hepatobiliary Pancreat Surg. 2003;10(1):31-44. doi: 10.1007/s10534-002-0734-7.
The utilization of partial-liver grafts for transplantation of adults represents an evolution from strategies designed to increase pediatric organ supply that have been justified by increased organ-waiting times and morbidity of adult transplant candidates. These techniques, which include adult-to-adult living-donor and split-liver transplantation, mandate particular surgical and medical considerations, as partial-liver grafts predispose to unique complications resulting from anatomic variations, technical considerations, and recipient physiology. Adult-to-adult living-donor liver transplantation has been successfully reported throughout the world; however, the magnitude of the donor operation has resulted in serious morbidity and donor mortality that have stimulated an ethical debate as to the future of this procedure. The limitations encountered in the application of adult-to-adult, living-donor liver transplantation have renewed interest in the successful implementation of split-liver transplantation between two adults from one adult cadaver donor. This manuscript details current technical considerations for the performance of adult-to-adult living-donor and split-liver transplantation, summarizes current outcomes, and explores the ethical dilemma of living-donation.
利用部分肝脏移植物进行成人肝移植，这是从旨在增加儿童器官供应的策略演变而来的，而这些策略是由于成人移植候选者等待器官时间的增加以及发病率上升而被证明合理的。这些技术，包括成人对成人活体供肝移植和劈离式肝移植，需要特殊的外科和医学考量，因为部分肝脏移植物容易引发因解剖变异、技术因素和受者生理状况导致的独特并发症。成人对成人活体供肝移植在世界各地均有成功报道；然而，供体手术的规模导致了严重的发病率和供体死亡率，引发了关于该手术未来走向的伦理辩论。成人对成人活体供肝移植应用中遇到的局限性，重新激发了人们对成功实施将一名成人尸体供体的肝脏劈离后移植给两名成人的兴趣。本文详细阐述了成人对成人活体供肝移植和劈离式肝移植目前的技术考量，总结了当前的治疗结果，并探讨了活体供肝的伦理困境。
