Freise C E, Gillespie B W, Koffron A J, Lok A S F, Pruett T L, Emond J C, Fair J H, Fisher R A, Olthoff K M, Trotter J F, Ghobrial R M, Everhart J E
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
Am J Transplant. 2008 Dec;8(12):2569-79. doi: 10.1111/j.1600-6143.2008.02440.x. Epub 2008 Oct 24.
Patients considering living donor liver transplantation (LDLT) need to know the risk and severity of complications compared to deceased donor liver transplantation (DDLT). One aim of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL) was to examine recipient complications following these procedures. Medical records of DDLT or LDLT recipients who had a living donor evaluated at the nine A2ALL centers between 1998 and 2003 were reviewed. Among 384 LDLT and 216 DDLT, at least one complication occurred after 82.8% of LDLT and 78.2% of DDLT (p = 0.17). There was a median of two complications after DDLT and three after LDLT. Complications that occurred at a higher rate (p < 0.05) after LDLT included biliary leak (31.8% vs. 10.2%), unplanned reexploration (26.2% vs. 17.1%), hepatic artery thrombosis (6.5% vs. 2.3%) and portal vein thrombosis (2.9% vs. 0.0%). There were more complications leading to retransplantation or death (Clavien grade 4) after LDLT versus DDLT (15.9% vs. 9.3%, p = 0.023). Many complications occurred more commonly during early center experience; the odds of grade 4 complications were more than two-fold higher when centers had performed <or=20 LDLT (vs. >40). In summary, complication rates were higher after LDLT versus DDLT, but declined with center experience to levels comparable to DDLT.
考虑活体供肝肝移植（LDLT）的患者需要了解与尸体供肝肝移植（DDLT）相比并发症的风险和严重程度。成人对成人活体供肝肝移植队列研究（A2ALL）的一个目的是检查这些手术后受体的并发症。回顾了1998年至2003年期间在9个A2ALL中心对活体供体进行评估的DDLT或LDLT受体的医疗记录。在384例LDLT和216例DDLT中，82.8%的LDLT和78.2%的DDLT术后至少发生了一种并发症（p = 0.17）。DDLT术后并发症的中位数为2种，LDLT术后为3种。LDLT术后发生率较高（p < 0.05）的并发症包括胆漏（31.8%对10.2%）、计划外再次探查（26.2%对17.1%）、肝动脉血栓形成（6.5%对2.3%）和门静脉血栓形成（2.9%对0.0%）。与DDLT相比，LDLT术后导致再次移植或死亡（Clavien 4级）的并发症更多（15.9%对9.3%，p = 0.023）。许多并发症在中心早期经验中更常见；当中心进行≤20例LDLT时，4级并发症的几率比进行>40例时高出两倍多。总之，LDLT术后的并发症发生率高于DDLT，但随着中心经验的增加而下降，降至与DDLT相当的水平。
