Lee Sung-Gyu
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2006 Mar;21(3):572-4. doi: 10.1111/j.1440-1746.2006.04283.x.
Although the shortage of brain-dead donor organs is a worldwide problem, the situation is especially serious in Asia because of various cultural and social reasons, and cadaveric organ donation remains below 5 per million population per year. Living donor liver transplantation (LDLT) could provide an alternative for liver graft for patients with acute and chronic end-stage liver disease. This article introduces the important contributions to the development of LDLT by the leading Asian liver transplantation centers. The first successful adult LDLT using a left-lobe graft was reported by Makuuchi et al. from Japan in 1994. To overcome the barrier of graft-size matching for adult patients with use of a left-lobe graft, a trial of adult LDLT using a right-lobe graft with middle hepatic vein was reported with satisfactory outcome by Fan et al. from Hong Kong in 1997. Despite the impressive results of right-lobe LDLT, considerable debate persists concerning donor safety. Lee et al. from Korea initiated modified right-lobe liver grafting with interposition vein grafts to drain anterior segment and two left-lobe liver grafting to overcome graft-size insufficiency and to ensure donor safety in 1999 and 2000, respectively. In addition to technical innovations, indications for liver transplantation have been developed by Asian centers as LDLT activity has increased.
尽管脑死亡供体器官短缺是一个全球性问题，但由于各种文化和社会原因，这种情况在亚洲尤为严重，尸体器官捐献率仍低于每年每百万人口5例。活体肝移植（LDLT）可为急慢性终末期肝病患者提供肝移植的替代方案。本文介绍了亚洲主要肝移植中心对LDLT发展的重要贡献。1994年，日本的幕内等报道了首例使用左叶移植物的成人LDLT成功案例。为克服使用左叶移植物时成人患者移植物大小匹配的障碍，1997年，香港的范等报道了使用含肝中静脉的右叶移植物进行成人LDLT的试验，结果令人满意。尽管右叶LDLT取得了令人瞩目的成果，但关于供体安全性仍存在相当大的争议。1999年和2000年，韩国的李等分别开展了改良右叶肝移植并置入静脉移植物以引流前段，以及开展了两例左叶肝移植以克服移植物大小不足并确保供体安全。除了技术创新，随着LDLT活动的增加，亚洲各中心还拓展了肝移植的适应证。
