Giacomoni A, De Carlis L, Lauterio A, Slim A O, Aseni P, Sammartino C, Mangoni I, Belli L S, De Gasperi A
Liver Transplant Unit, Niguarda Hospital, Milano, Italy.
Transplant Proc. 2005 Mar;37(2):1167-9. doi: 10.1016/j.transproceed.2004.12.176.
Although right hemiliver transplant from living donors (LD) is gaining acceptance as a way to overcome the critical organ shortage, splitting a liver for two adults from cadaveric donor (CD) is still controversial.
From May 1999 to August 2004 we performed nine right hemiliver transplants using segments 5-6-7-8 from CD and 18 from LD.
We compared the two procedures to evaluate both the technical aspects and the patients' outcomes. In the CD group, three recipients died (33%), two of whom were UNOS Status 2A. Patient and graft survivals were 67% (median follow-up: 23 months). Among the LD group, three recipients died (17%) and two were retransplanted; one because of arterial thrombosis and the other as a consequence of small-for-size syndrome. Patient and graft survivals were 83% and 72%, respectively (median follow-up: 8 months). There were five early complications in the CD group (55%) and five (27%) in the LD group. Two patients in the LD group experienced a late stenosis of the biliary anastomosis.
Data from our early experience show that better results are achieved by right hemiliver transplants from LD; the morbidity and mortality are higher among the CD group. We believe that this finding is probably a consequence of better preoperative donor evaluation, shorter ischemia time, better logistics, and learning curve. Recipient selection is crucial; this kind of graft is at high risk of poor function, technical complications, and infections. Further experience will help to clarify the reliability of right hemiliver transplants from CD.
尽管活体供者右半肝移植作为克服关键器官短缺的一种方式正逐渐被接受，但将尸体供者肝脏分割给两名成人仍存在争议。
1999年5月至2004年8月，我们使用尸体供者的第5 - 6 - 7 - 8段进行了9例右半肝移植，使用活体供者的肝脏进行了18例右半肝移植。
我们比较了这两种手术方式，以评估技术方面和患者的预后。在尸体供者组中，3名受者死亡（33%），其中2名是器官共享联合网络（UNOS）2A级状态。患者和移植物存活率为67%（中位随访时间：23个月）。在活体供者组中，3名受者死亡（17%），2名接受了再次移植；1例是由于动脉血栓形成，另1例是由于小肝综合征。患者和移植物存活率分别为83%和72%（中位随访时间：8个月）。尸体供者组有5例早期并发症（55%），活体供者组有5例（27%）。活体供者组有2例患者发生了胆管吻合口晚期狭窄。
我们早期经验的数据表明，活体供者右半肝移植取得了更好的结果；尸体供者组的发病率和死亡率更高。我们认为这一发现可能是由于更好的术前供者评估、更短的缺血时间、更好的后勤保障以及学习曲线的结果。受者选择至关重要；这种移植物功能不良、技术并发症和感染的风险很高。进一步的经验将有助于阐明尸体供者右半肝移植的可靠性。
