Adam René, McMaster Paul, O'Grady John G, Castaing Denis, Klempnauer Jurgen L, Jamieson Neville, Neuhaus Peter, Lerut Jan, Salizzoni Mauro, Pollard Stephen, Muhlbacher Ferdinand, Rogiers Xavier, Garcia Valdecasas Juan Carlos, Berenguer Joaquin, Jaeck Daniel, Moreno Gonzalez Enrique
European Liver Transplant Registry, Villejuif, France.
Liver Transpl. 2003 Dec;9(12):1231-43. doi: 10.1016/j.lts.2003.09.018.
The European Liver Transplant Registry (ELTR) currently allows for the analysis of 44,286 liver transplantations (LTs) performed on 39,196 patients in a 13-year period. After an exponential increase, the number of LTs is plateauing due to a lack of organs. To cope with this, alternatives to cadaveric LT, such as split LT, domino LT, or living-related LT (LRLT) are being used increasingly. They now account for 11% of all procedures. One of the most important findings in the evolution of LT is the considerable improvement of results along time with, for the mean time, a one-year survival of 83%, all indications confounded. The improvement is particularly significant for cancers. This improvement is mainly represented by hepatocellular carcinoma, with a gain of 17% for 5-year survival rate from 1990 to 2000. Increasingly, older donors are used to augment the donor pool and older recipients are transplanted due to improved results and a better selection of patients. More than two thirds of deaths and three quarters of retransplantations occurred within the first year of transplantation. Retransplantation is associated with much less optimal results than first LT. One of the prominent features of recent years is the development of LRLT. LRLT is now performed by almost half of the European centers. As with split LT or domino LT, LRLT aims to provide more patients to be transplanted. Special attention is paid to reducing the risk for the donor, which is now estimated to be 0.5% mortality and 21% postoperative morbidity.
欧洲肝脏移植登记处（ELTR）目前允许对13年间39196名患者进行的44286例肝脏移植（LT）进行分析。在经历指数增长后，由于器官短缺，肝脏移植数量正趋于平稳。为应对这一情况，尸体肝移植的替代方法，如劈离式肝移植、多米诺肝移植或活体亲属肝移植（LRLT）的使用越来越多。它们现在占所有手术的11%。肝移植发展过程中最重要的发现之一是随着时间推移结果有了显著改善，平均而言，所有适应证综合起来的一年生存率为83%。对于癌症患者，这种改善尤为显著。这种改善主要体现在肝细胞癌方面，1990年至2000年5年生存率提高了17%。越来越多地使用年龄较大的供体来扩大供体库，并且由于结果改善和患者选择更好，年龄较大的受者也接受了移植。超过三分之二的死亡和四分之三的再次移植发生在移植后的第一年内。再次移植的结果远不如首次肝移植理想。近年来的一个突出特点是活体亲属肝移植的发展。现在几乎一半的欧洲中心都开展了活体亲属肝移植。与劈离式肝移植或多米诺肝移植一样，活体亲属肝移植旨在为更多患者提供移植机会。特别关注降低供体风险，目前估计供体死亡率为0.5%，术后发病率为21%。
