Russo Mark W, Brown Robert S
Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Am J Transplant. 2004 Apr;4(4):458-65. doi: 10.1111/j.1600-6143.2004.00387.x.
Adult living donor liver transplantation (LDLT) begun in response to deceased donor organ shortage and waiting list mortality, grew rapidly after its first general application in the United States in 1998. There are significant risks to the living donor, including the risk of death and substantial morbidity, and two highly publicized donor deaths have led to decreased LDLT since 2001. Significant improvements in outcomes have been seen over recent years that have not been reported in single center studies; however, LDLT still comprises less than 5% of adult liver transplants, significantly less than in kidney transplantation where living donors now comprise the majority. The ethics, optimal utility and application of LDLT remain to be defined. In addition, studies to date have focused on post-transplant outcomes and not included the potential impact of LDLT on waiting time mortality. Future analyses should include appropriate control or comparison groups that capture the effect of LDLT on overall mortality from the time of listing. Further growth of LDLT will depend on defining the optimal recipient and donor characteristics for this procedure as well as broader acceptance and experience in the public and in transplant centers.
成人活体肝移植（LDLT）始于应对尸体供肝短缺及等待名单上的患者死亡情况，自1998年首次在美国广泛应用后迅速发展。活体供者面临重大风险，包括死亡风险和严重并发症，自2001年以来，两起备受关注的供者死亡事件导致LDLT数量减少。近年来，移植效果有显著改善，单中心研究尚未报道这一点；然而，LDLT在成人肝移植中仍占不到5%，远低于活体供者占多数的肾移植。LDLT的伦理、最佳效用及应用仍有待明确。此外，迄今为止的研究集中在移植后的结果，未包括LDLT对等待时间死亡率的潜在影响。未来分析应纳入适当的对照组或比较组，以了解从列入名单之时起LDLT对总体死亡率的影响。LDLT的进一步发展将取决于确定该手术的最佳受者和供者特征，以及公众和移植中心更广泛的接受度和经验。
