Wiederkehr J C, Pereira J C, Ekermann M, Porto F, Kondo W, Nagima I, Amaral W, Camargo C A, Moreira M
Santa Casa de Curitiba and Hospital Pequeno Principe, Catholic University of Parana PUCPR, Parana, Brazil.
Transplant Proc. 2005 Mar;37(2):1079-80. doi: 10.1016/j.transproceed.2004.12.221.
Liver transplant is the primary therapy for patients with end-stage liver disease. Its high success rates have lead to a broadening of the indications for liver transplantation, resulting in an increasing shortage of donors. Living donor liver transplantation has become an option to overcome waiting list mortality. We describe our experience with hepatectomy for living donor liver transplantation and report a case of death.
Patients (n = 132) underwent hepatectomy for living donor liver transplantation from June 2000 through June 2004. A 4-phase preoperative evaluation was performed on all patients, whose ages ranged from 13 to 54 years (mean = 29.7 +/- 8.1 years). Of the 132 patients, 76 patients (57.5%) underwent left lateral segmentectomy, 33 patients (25%) underwent left lobectomy, and 23 patients (16%) underwent right hepatectomy. In 2 other patients (1.5%), a monosegment (segment II) was obtained after left lateral segmentectomy.
Twenty patients (15%) experienced a complication, the most common being incisional hernia, pneumonia, and biliary fistulae. On the seventh postoperative day, 1 patient developed a fatal cerebral hemorrhage while recovering from mild liver dysfunction.
Although living donor liver transplantation is generally safe, serious and fatal complications may occur.
肝移植是终末期肝病患者的主要治疗方法。其高成功率导致肝移植适应证不断扩大，进而造成供体日益短缺。活体供肝肝移植已成为克服等待名单上患者死亡的一种选择。我们描述了我们在活体供肝肝移植肝切除术中的经验并报告了一例死亡病例。
2000年6月至2004年6月期间，132例患者接受了活体供肝肝移植的肝切除术。对所有患者进行了4期术前评估，患者年龄在13至54岁之间（平均 = 29.7 ± 8.1岁）。132例患者中，76例（57.5%）接受了左外叶切除术，33例（25%）接受了左半肝切除术，23例（16%）接受了右肝切除术。另外2例患者（1.5%）在左外叶切除术后获得了单一段（第二段）。
20例患者（15%）出现并发症，最常见的是切口疝、肺炎和胆瘘。术后第7天，1例患者在从轻度肝功能障碍恢复过程中发生致命性脑出血。
虽然活体供肝肝移植总体上是安全的，但可能会发生严重和致命的并发症。
