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成人活体供肝肝移植:右肝叶活体捐赠

Adult living donor liver transplantation: living donation of the right liver lobe.

作者信息

Mittler J, Pascher A, Jonas S, Pratschke J, Neumann U P, Langrehr J M, Neuhaus P

机构信息

Department of General, Visceral and Transplant Surgery, Charité-Campus Virchow Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

出版信息

Langenbecks Arch Surg. 2007 Nov;392(6):657-62. doi: 10.1007/s00423-007-0187-0. Epub 2007 Apr 14.

Abstract

BACKGROUND

Adult living donor liver transplantation (LDLT) has become a routine treatment option for patients waiting for liver transplantation. In European and North American countries, LDLT for adult recipients is mainly performed with right lobe grafts. Indications, when compared to deceased donor liver transplantation, are controversial.

MATERIALS AND METHODS

In our institution, patients suffering from hepatocellular carcinoma in cirrhosis, non-resectable hilar cholangiocarcinoma, viral hepatitis associated cirrhosis, as well as cholestatic liver and biliary disease are considered good candidates for LDLT.

RESULTS

In this overview, donor evaluation, graft selection, and the donor operation with special regard to operative techniques and strategies are discussed. For visualization, a 5-min video sequence of the standard donor operation as performed in our institution is attached.

CONCLUSION

Given the ongoing shortage of donor organs, adult LDLT has become a routine treatment option for patients waiting for liver transplantation. The associated inevitable risk for the healthy donor, however, remains ethically controversial.

摘要

背景

成人活体肝移植(LDLT)已成为等待肝移植患者的常规治疗选择。在欧洲和北美国家,成人受者的LDLT主要采用右叶移植物进行。与尸体供肝移植相比,其适应证存在争议。

材料与方法

在我们机构,患有肝硬化合并肝细胞癌、不可切除的肝门部胆管癌、病毒性肝炎相关性肝硬化以及胆汁淤积性肝脏和胆道疾病的患者被认为是LDLT的合适候选者。

结果

在本综述中,讨论了供体评估、移植物选择以及特别关注手术技术和策略的供体手术。为便于直观了解,附上了一段在我们机构进行的标准供体手术的5分钟视频片段。

结论

鉴于供体器官持续短缺,成人LDLT已成为等待肝移植患者的常规治疗选择。然而,对健康供体不可避免的相关风险在伦理上仍存在争议。

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