Taketomi Akinobu, Kayashima Hiroto, Soejima Yuji, Yoshizumi Tomoharu, Uchiyama Hideaki, Ikegami Toru, Yamashita Yoichi, Harada Noboru, Shimada Mitsuo, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Transplantation. 2009 Feb 15;87(3):445-50. doi: 10.1097/TP.0b013e3181943d46.
To ensure donor safety in adult-to-adult living donor liver transplantation, we established a selection criterion for donors in which left lobe (LL) was the first choice of graft.
Two hundred six consecutive donors were retrospectively studied. Donors were divided into two groups according to graft type: LL graft (n=137) and right lobe (RL) graft (n=69).
Although mean intraoperative blood loss of LL was significantly increased compared with RL, mean peak postoperative total bilirubin levels and duration of hospital stay after surgery were significantly less for LL than RL (P<0.05). No donor died or suffered a life-threatening complication during the study period. The overall complication rate was 34.0%, including biliary complications in 5.3%. The number of biliary complications was four (2.9%) in LL and seven (10.1%) in RL (P<0.05). Logistic regression analysis revealed that only graft type (LL vs. RL) is significantly related to the occurrence of biliary complications (odds ratio 0.11; P=0.0012). The cumulative overall graft survival rates in the recipients with LL were not significantly different from that in the recipients with RL.
LL grafting should be considered favorably when selecting donors for adult-to-adult living donor liver transplantation.
为确保成人活体肝移植供体的安全，我们制定了一项供体选择标准，即首选左叶作为移植肝。
对206例连续的供体进行回顾性研究。根据移植肝类型将供体分为两组：左叶移植组（n = 137）和右叶移植组（n = 69）。
虽然左叶移植术中平均失血量较右叶显著增加，但左叶移植术后平均总胆红素峰值水平和术后住院时间均显著低于右叶（P < 0.05）。在研究期间，无供体死亡或发生危及生命的并发症。总体并发症发生率为34.0%，其中胆系并发症发生率为5.3%。左叶胆系并发症有4例（2.9%），右叶有7例（10.1%）（P < 0.05）。Logistic回归分析显示，仅移植肝类型（左叶与右叶）与胆系并发症的发生显著相关（比值比0.11；P = 0.0012）。接受左叶移植受体的累积总体移植肝生存率与接受右叶移植的受体相比无显著差异。
在为成人活体肝移植选择供体时，应优先考虑左叶移植。
