Rudow Dianne Lapointe, Brown Robert S, Emond Jean C, Marratta Douglas, Bellemare Sarah, Kinkhabwala Milan
Center for Liver Disease and Transplantation, New York Presbyterian Hospital, New York, NY 10032, USA. dl349@columbia .edu
Liver Transpl. 2004 Nov;10(11):1428-31. doi: 10.1002/lt.20280.
Live donors are becoming an increasingly important source of donor organs in liver transplantation; however, long-term functional aspects of recovery from donor right hepatectomy are unknown. We analyzed donor outcomes at 1-year follow-up. We performed a single-center retrospective analysis of 70 right hepatectomy donors. Six-week and 1-year postoperative follow-up results were compared to preoperative baseline values. Ultrasonography was performed in all donors at 6 weeks and as clinically indicated. All donors were alive and well at the end of the study period. Of 66 right hepatic donors, only 22 (32%) were fully compliant with a 1-year follow-up visit. All those not compliant were contacted by phone. All complications except 1 (late finding of portal vein thrombosis) occurred in the perioperative (90-day) period. The incidence of bile leak was 4.3%, incisional hernia 20%, and autologous transfusion 1.0%. There were no aborted procedures. In those compliant with full 1-year follow-up, total bilirubin, aspartate aminotransferase, and alanine aminotransferase were normal in 97%. A total of 5 donors were noted to have persistence of asymptomatic thrombocytopenia beyond the perioperative period (90 days). These were investigated with Doppler sonography. Sonography was unremarkable in 3 of the 5, while 2 had abnormal findings: splenomegaly alone in 1, and splenomegaly with portal vein thrombosis in the other. Magnetic resonance angiography was performed in both, and the patient with portal vein thrombosis underwent endoscopy, which failed to reveal varices. Neither has clinical portal hypertension. Both remain asymptomatic albeit with stable thrombocytopenia. In conclusion, the majority of complications after donor right hepatectomy occur in the perioperative period. Later findings may include asymptomatic thrombocytopenia, with an incidence possibly as high as 23%, though the significance of this finding remains uncertain. Larger-scale studies are needed to confirm the true incidence and clinical significance of persistent thrombocytopenia in the donor hepatectomy population. Strategies to improve compliance with 1-year follow-up visits need to be developed.
活体供体正日益成为肝移植中供体器官的重要来源；然而，供体右半肝切除术后恢复的长期功能方面尚不清楚。我们分析了1年随访期的供体结局。我们对70例右半肝切除供体进行了单中心回顾性分析。将术后6周和1年的随访结果与术前基线值进行比较。所有供体在术后6周以及临床需要时进行超声检查。在研究期末所有供体均存活且状况良好。在66例右半肝供体中，只有22例（32%）完全遵守了1年的随访。所有未遵守的供体均通过电话联系。除1例（门静脉血栓形成的晚期发现）外，所有并发症均发生在围手术期（90天）。胆漏发生率为4.3%，切口疝为20%，自体输血为1.0%。无手术中止情况。在完全遵守1年随访的供体中，97%的总胆红素、天冬氨酸转氨酶和丙氨酸转氨酶正常。共有5例供体在围手术期（90天）后出现无症状性血小板减少症持续存在。对这些供体进行了多普勒超声检查。5例中有3例超声检查无异常，而2例有异常发现：1例仅有脾肿大，另1例有脾肿大合并门静脉血栓形成。对这2例均进行了磁共振血管造影，门静脉血栓形成的患者接受了内镜检查，未发现静脉曲张。两者均无临床门静脉高压。尽管血小板减少症持续稳定，但两者均无症状。总之，供体右半肝切除术后的大多数并发症发生在围手术期。后期发现可能包括无症状性血小板减少症，发生率可能高达23%，尽管这一发现的意义仍不确定。需要开展更大规模的研究来证实供体肝切除人群中持续性血小板减少症的真实发生率和临床意义。需要制定提高1年随访依从性的策略。
