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伊朗活体肝移植经验:单中心报告。

Experience of living donor liver transplantation in Iran: a single-center report.

作者信息

Nikeghbalian S, Nejatollahi S M, Salahi H, Bahador A, Dehghani S M, Kazemi K, Dehghani M, Kakaei F, Ghaffaripour S, Sattari H, Gholami S, Anvari E, Malek-Hosseini S A

机构信息

Department of Hepatobiliary and Transplantation Surgery, Shiraz Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran.

出版信息

Transplant Proc. 2009 Sep;41(7):2868-71. doi: 10.1016/j.transproceed.2009.07.009.

Abstract

BACKGROUND

Living donor liver transplantation (LDLT) has been accepted as a valuable treatment for patients with end-stage liver disease seeking to overcome the shortage of organs and the waiting list mortality. The aim of this study was to report our experience with LDLT.

METHODS

We retrospectively analyzed 50 LDLTs performed in our organ transplant center from January 1997 to March 2008. We reviewed the demographic data, family history, operative and hospital stay durations as well as postoperation complications among donors and recipients. We also performed a retrospective analysis of recipient chemical and biochemical data.

RESULTS

Among 50 patients (30 males and 20 females) of overall mean age of 7.21 +/- 5.35 who underwent LDLT (10 right lobe, 38 left lobe, and 2 left lateral segments), 47 received a liver graft from their parent, two from a brother, and one from an uncle. The most common indications for LDLT were end-stage liver disease due to Wilson's disease (16%), cryptogenic cirrhosis (16%), tyrosinemia (14%), biliary atresia (12%), autoimmune hepatitis (12%), and progressive familial intrahepatic cholestasis (12%). The mean follow-up was 16.91 +/- 23.74 months. There were 13 (26%) recipient mortalities including vascular complications; three to sepsis after bowel perforation, two from liver dysfunction, two from chronic rejection due to noncompliance, and one from diffuse aspergillosis. The morbidity rate was 50%, including 19 reexplorations during the hospital course and five biliary complications.

CONCLUSION

This study demonstrated that LDLT can decrease the number of patients awaiting liver transplantation especially in the pediatric group. However, because of relatively high mortality and morbidity, we must improve our treatment outcomes.

摘要

背景

活体供肝肝移植(LDLT)已被公认为是一种有价值的治疗方法,可用于终末期肝病患者,以克服器官短缺和等待名单上的死亡率问题。本研究的目的是报告我们在LDLT方面的经验。

方法

我们回顾性分析了1997年1月至2008年3月在我们器官移植中心进行的50例LDLT手术。我们审查了供体和受体的人口统计学数据、家族史、手术和住院时间以及术后并发症。我们还对受体的化学和生化数据进行了回顾性分析。

结果

在50例接受LDLT的患者(30例男性和20例女性)中,总体平均年龄为7.21±5.35岁(10例接受右叶移植,38例接受左叶移植,2例接受左外侧段移植),47例从其父母处接受肝移植,2例从兄弟处接受,1例从叔叔处接受。LDLT最常见的适应证是威尔逊病所致终末期肝病(16%)、隐源性肝硬化(16%)、酪氨酸血症(14%)、胆道闭锁(12%)、自身免疫性肝炎(12%)和进行性家族性肝内胆汁淤积症(12%)。平均随访时间为16.91±23.74个月。有13例(26%)受体死亡,包括血管并发症;3例因肠穿孔后败血症死亡,2例因肝功能障碍死亡,2例因不依从导致慢性排斥反应死亡,1例因弥漫性曲霉病死亡。发病率为50%,包括住院期间19例再次手术和5例胆道并发症。

结论

本研究表明,LDLT可以减少等待肝移植的患者数量,尤其是在儿科患者中。然而,由于死亡率和发病率相对较高,我们必须改善治疗效果。

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