Cariús L P, Pacheco-Moreira L F, Balbi E, Leal C R G, Gonzalez A C, Agoglia L V, Araújo C, Enne M, Martinho J M
Liver Transplantation Unit, Bonsucesso General Hospital, Rio de Janeiro, Brazil.
Transplant Proc. 2009 Apr;41(3):895-7. doi: 10.1016/j.transproceed.2009.02.007.
Orthotopic liver transplantation (OLT) is the principal therapy for acute liver failure (ALF). The mortality on the waiting list for deceased donor liver transplantation (DDLT) is high, principally in countries where donation rates are low. Living donor liver transplantation (LDLT) seems an option for the treatment of ALF, although some ethical issues need to be considered. Herein we have evaluated LDLT results among patients with ALF and discussed the ethical aspects of procedures performed in emergency situations.
From March 2002 to October 2008, we performed 301 liver transplantations, including 103 from living donors. ALF was responsible for 10.6% of all transplantations; LDLT was only considered for pediatric recipients among whom 7 children displayed ALF.
One patient died on postoperative day 33 due to hepatic artery thrombosis. One patient died at 2 months after transplantation due to biliary sepsis, resulting in an overall survival rate of 71%. The average time for donor discharge was 5 days. No mortality or major complications were observed.
The survival of children with ALF undergoing LDLT was comparable to published data. Furthermore, despite the fact that the available time to prepare the donors was limited, no serious complications were observed in the postoperative period. Thus, using living donors for children with ALF is an effective, safe alternative that can be extremely useful in countries with low donation rates.
原位肝移植（OLT）是急性肝衰竭（ALF）的主要治疗方法。在尸体供肝肝移植（DDLT）等待名单上的患者死亡率很高，主要是在供体捐献率低的国家。活体供肝肝移植（LDLT）似乎是治疗ALF的一种选择，尽管需要考虑一些伦理问题。在此，我们评估了ALF患者的LDLT结果，并讨论了在紧急情况下进行手术的伦理问题。
从2002年3月至2008年10月，我们进行了301例肝移植手术，其中包括103例活体供肝移植。ALF占所有移植手术的10.6%；仅考虑对儿童受者进行LDLT，其中7名儿童患有ALF。
1例患者术后33天因肝动脉血栓形成死亡。1例患者在移植后2个月因胆系感染死亡，总体生存率为71%。供体平均出院时间为5天。未观察到死亡或严重并发症。
接受LDLT的ALF儿童的生存率与已发表的数据相当。此外，尽管准备供体的可用时间有限，但术后未观察到严重并发症。因此，对ALF儿童使用活体供肝是一种有效、安全的替代方法，在供体捐献率低的国家可能非常有用。
