Collett Dave, O'Neill John, Neuberger James
UK Transplant, Stoke Gifford, Bristol, UK.
Transpl Int. 2008 Mar;21(3):218-22. doi: 10.1111/j.1432-2277.2007.00553.x. Epub 2007 Sep 11.
Division of donor livers has allowed effective expansion of the donor pool and has been associated with a reduction in the mortality of children awaiting liver transplantation. However, adult recipients of a split graft tend to have inferior transplant survival, compared with recipients of a whole graft. We have analysed the impact of the splitting programme at a particular centre on the life-years lost or gained in both adult and paediatric recipients. We estimate that at 1 year after transplantation, splitting livers has resulted in a gain of five life-years for the paediatric recipients with a loss of six adult patient years; at 5 years post-transplant, a gain of 25 life-years for the paediatric recipients balances a loss of 30 life-years for adult recipients. While this analysis is based on a number of assumptions, and so the results must be treated with caution, it does give rise to a number of ethical considerations which require open and public debate.
供肝分割使得供肝库得以有效扩充，并与等待肝移植儿童的死亡率降低相关。然而，与接受全肝移植的受者相比，接受劈裂式肝移植的成年受者移植后的生存率往往较低。我们分析了某一特定中心的肝分割项目对成年和儿童受者生命年数得失的影响。我们估计，在移植后1年，肝分割为儿童受者带来了5个生命年的增益，而成年患者损失了6个生命年；移植后5年，儿童受者获得25个生命年的增益，与成年受者损失的30个生命年相平衡。虽然该分析基于一些假设，因此结果必须谨慎对待，但它确实引发了一些需要公开和公众辩论的伦理考量。
