Northup Patrick Grant, Berg Carl Lansing
Division of Gastroenterology and Hepatology, Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, VA, USA.
Health Policy. 2005 May;72(2):175-85. doi: 10.1016/j.healthpol.2004.08.014.
Adult-to-adult living donor liver transplantation (LDLT) is in a state of flux. Technical innovations and demand have outpaced internal and external regulatory efforts. This has led to a wide array of centers performing LDLT for a variety of indications without clear evidence on the risks to the donor or recipient or the system as a whole. The birth from necessity of LDLT in Asia has led to the extrapolation of the technique in America and Europe that has not been sufficiently studied in the appropriate populations. While there is a clear benefit in some patients, the appropriate donors and recipients have not been defined. Regulatory and ethical consideration should be focused on minimizing acceptable risk in donors and recipients and expanding the investigation into the costs and outcomes of this challenging procedure. The recently funded adult-to-adult living donor liver transplantation cohort sponsored by the National Institutes of Health aims to answer some of these questions over the next five years.
成人对成人活体肝移植（LDLT）正处于不断变化的状态。技术创新和需求已超过内部和外部监管的努力。这导致大量中心针对各种适应症开展LDLT，但对于供体、受体或整个系统的风险却没有明确证据。LDLT在亚洲因需求而生，导致该技术在美国和欧洲被推广应用，而在合适人群中尚未得到充分研究。虽然对某些患者有明显益处，但合适的供体和受体尚未明确界定。监管和伦理考量应聚焦于将供体和受体的可接受风险降至最低，并扩大对这一具有挑战性手术的成本和结果的调查。美国国立卫生研究院最近资助的成人对成人活体肝移植队列研究旨在在未来五年内回答其中一些问题。
