Dazzi A, Lauro A, Di Benedetto F, Masetti M, Cautero N, De Ruvo N, Quintini C, Ramacciato G, Miller C M, Pinna A D
Liver and Multiorgan Transplant Unit, University of Bologna, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2595-6. doi: 10.1016/j.transproceed.2005.06.061.
Living donation in adult liver transplantation (LDLTx) is an important resource because of the waiting list growth. We started a living donor program to overcome the shortage of cadaveric sources.
From May 2001 to May 2003, 36 patients underwent LDLTx: 27 received a right lobe, 8 received a left lobe, and 1 received segments II and III.
The 1-year actuarial survival rate was 77.7%, with a mean follow-up, in survivors, of 754 +/- 248 days. Eleven of 27 (40.7%) right lobe recipients died. Among left graft recipients, 3 patients died (33%). We undertook retransplantation in 4 cases, because of 2 "small for size" syndrome, 1 late hepatic artery thrombosis, and 1 early portal vein thrombosis. After a period of 797 days, all 36 donors returned to a normal social and working life. Two donors, who underwent right lobe donation, experienced major complications: 1 case of biliary stenosis, treated by stenting, and 1 case of biliary leak from the cut surface of the liver, requiring laparotomy and abscess drainage. Left lobe donors developed no complications.
LDLTx has a learning curve for experienced liver transplantation surgeons. Our last 18 cases showed better survivals than the first 18 (9 deaths vs 5), even if, in the latter group, we transplanted 8 left livers. In our experience, LDLTx of a left liver graft has an increased risk of "small for size syndrome," but patients, both donors and recipients, report improved outcomes.
由于等待名单的增加，成人肝移植中的活体供肝是一种重要的资源。我们启动了一个活体供者项目以克服尸体供肝来源的短缺。
2001年5月至2003年5月，36例患者接受了活体肝移植：27例接受右叶供肝，8例接受左叶供肝，1例接受第II和III段供肝。
1年实际生存率为77.7%，存活者的平均随访时间为754±248天。27例右叶供肝受者中有11例（40.7%）死亡。左叶供肝受者中有3例（33%）死亡。因2例“小肝综合征”、1例晚期肝动脉血栓形成和1例早期门静脉血栓形成，我们对4例患者进行了再次移植。797天后，所有36名供者均恢复了正常的社会和工作生活。2例接受右叶供肝的供者出现了严重并发症：1例胆管狭窄，通过支架置入治疗；1例肝切面胆漏，需要开腹手术和脓肿引流。左叶供者未发生并发症。
对于有经验的肝移植外科医生来说，活体肝移植有一个学习曲线。我们最后18例的生存率高于前18例（9例死亡对5例），即使在后一组中我们移植了8例左肝。根据我们的经验，左肝活体肝移植发生“小肝综合征”的风险增加，但供者和受者的预后均有所改善。
