Pomposelli J J, Verbesey J, Simpson M A, Lewis W D, Gordon F D, Khettry U, Wald C, Ata S, Morin D, Garrigan K, Jenkins R L, Pomfret E A
Division of Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
Am J Transplant. 2006 Mar;6(3):589-98. doi: 10.1111/j.1600-6143.2005.01220.x.
We present our program experience with 85 live donor adult liver transplantation (LDALT) procedures using right lobe grafts with five simultaneous live donor kidney transplants using different donors performed over a 6-year period. After an "early" 2-year experience of 25 LDALT procedures, program improvements in donor and recipient selection, preoperative imaging, donor and recipient surgical technique and immunosuppressive management significantly reduced operative mortality (16% vs. 3.3%, p = 0.038) and improved patient and graft 1-year survival in recipients during our "later" experience with the next 60 cases (January 2001 and March 2005; patient survival: early 70.8% vs. later 92.7%, p = 0.028; graft survival: Early 64% vs. later 91.1%, p = 0.019, respectively). Overall patient and graft survival were 82% and 80%. There was a trend for less postoperative complications (major and minor) with program experience (early 88% vs. later 66.7%; p = 0.054) but overall morbidity remained at 73.8%. Biliary complications (cholangitis, disruption, leak or stricture) were not influenced by program experience (early 32% vs. later 38%). Liver volume adjusted to 100% of standard liver volume (SLV) within 1 month post-transplant. Despite a high rate of morbidity after LDALT, excellent patient and graft survival can be achieved with program experience.
我们介绍了我们在85例成人活体供肝肝移植（LDALT）手术中的项目经验，这些手术使用右叶移植物，并在6年期间同时进行了5例使用不同供体的活体供肾移植。在经历了25例LDALT手术的“早期”2年经验后，在供体和受体选择、术前成像、供体和受体手术技术以及免疫抑制管理方面的项目改进显著降低了手术死亡率（16%对3.3%，p = 0.038），并在我们接下来60例的“后期”经验中提高了受体的患者和移植物1年生存率（2001年1月至2005年3月；患者生存率：早期70.8%对后期92.7%，p = 0.028；移植物生存率：早期64%对后期91.1%，p = 0.019）。总体患者和移植物生存率分别为82%和80%。随着项目经验的增加，术后并发症（主要和次要）有减少的趋势（早期88%对后期66.7%；p = 0.054），但总体发病率仍为73.8%。胆道并发症（胆管炎、破裂、渗漏或狭窄）不受项目经验的影响（早期32%对后期38%）。移植后1个月内肝脏体积调整至标准肝脏体积（SLV）的100%。尽管LDALT术后发病率较高，但通过项目经验仍可实现出色的患者和移植物生存率。
