Graziadei Ivo W
Division of Gastroenterology & Hepatology, Department of Internal Medicine, Medical University of Innsbruck, Austria, Anichstrasse 35, A-6020 Innsbruck, Austria.
Trop Gastroenterol. 2007 Apr-Jun;28(2):45-50.
Initially living donor liver transplantation (LDLT) was almost exclusively performed in infants and children. Adult LDLT programmes were initiated several years later. In the west this programme was introduced in view of a critical shortage of deceased donors and a constant increase in waiting list mortality. At present, this procedure is accepted as a therapeutic option for patients with end-stage liver disease to make up for the shortage of donor organs from dead patients. In Asia, however, LDLT has become the predominant means of liver transplantation as donor organs from the diseased cannot be used for religious and ethical reasons. Although there have been significant improvements in surgical techniques and consequently in recipient outcome over recent years, the LDLT procedure is still associated with donor morbidity and even mortality. The overall reported donor mortality was 0.2% and donor morbidity ranged between 0% and 100%. Biliary complications and infections were the most commonly reported donor complications. Therefore, a thorough medical as well as psychological evaluation of the donor and recipient are necessary prior to this procedure. To date, LDLT comprises less than 5% of adult liver transplantations in Europe and in the United States. Recipient and graft survival are almost identical to those seen with liver transplantations from deceased donors (DD). Biliary and vascular complications are more often seen in the LDLT setting. So far, no studies have focussed on the impact of LDLT on waiting list mortality. There is international consensus that this procedure should be restricted to centres with large experience in deceased donor liver transplantations as well as in hepatobiliary surgery. Ethical issues, optimal utility and application of adult LDLT and optimal recipient and donor characteristics have yet to be defined.
最初，活体肝移植（LDLT）几乎仅在婴儿和儿童中进行。几年后启动了成人LDLT项目。在西方，鉴于已故供体严重短缺以及等待名单上的死亡率不断上升，引入了该项目。目前，该手术被视为终末期肝病患者的一种治疗选择，以弥补已故患者供体器官的短缺。然而，在亚洲，由于宗教和伦理原因，患病者的供体器官无法使用，LDLT已成为肝移植的主要方式。尽管近年来手术技术有了显著改进，受体的治疗效果也随之提高，但LDLT手术仍与供体的发病率甚至死亡率相关。报告的总体供体死亡率为0.2%，供体发病率在0%至100%之间。胆道并发症和感染是最常报告的供体并发症。因此，在进行该手术之前，对供体和受体进行全面的医学和心理评估是必要的。迄今为止，在欧洲和美国，LDLT在成人肝移植中所占比例不到5%。受体和移植物的存活率与已故供体（DD）肝移植的情况几乎相同。在LDLT情况下，胆道和血管并发症更为常见。到目前为止，尚无研究关注LDLT对等待名单死亡率的影响。国际上一致认为，该手术应限于在已故供体肝移植以及肝胆外科方面经验丰富的中心。成人LDLT的伦理问题、最佳效用和应用以及最佳受体和供体特征尚未明确。
