Multiorgan Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Am J Transplant. 2010 Mar;10(3):612-8. doi: 10.1111/j.1600-6143.2009.02979.x. Epub 2010 Jan 29.
Donor safety is the paramount concern of living donor liver transplantation (LDLT). Although LDLT is employed worldwide, there is little data on rates and causes of 'no go' hepatectomies-patients brought to the operating room for possible donor hepatectomy whose procedure was aborted. We performed a single-center, retrospective review of all patients brought to the operating room for donor hepatectomy between October 2000 and November 2008. Of 257 right lobe donors, the donor operation was aborted in 12 cases (4.7%). The main reasons for stopping the operation were aberrant ductal or vascular anatomy (seven cases), unsuitable liver quality (three cases) or unexpected intraoperative events (two cases). Over the median period of follow-up of 23 months, there were no long-term complications of patients with aborted donor procedures. This report focuses exclusively on an important issue: the frequency and causes of no go decisions at a single large volume North American LDLT center. The rate of no go donor hepatectomies should be as low as possible without compromising donor safety--however, even with rigorous preoperative evaluation the rate of donor abortions will be significant. The default surgical position should always be to abort the donor operation if there is an unexpected finding that places the donor at increased risk.
供体安全是活体肝移植（LDLT）的首要关注点。虽然 LDLT 在全球范围内得到应用，但对于“无法进行”肝切除术（即患者被带到手术室进行可能的供肝切除术，但手术被中止）的发生率和原因的数据却很少。我们对 2000 年 10 月至 2008 年 11 月期间所有被带到手术室进行供肝切除术的患者进行了单中心回顾性研究。在 257 例右叶供体中，有 12 例（4.7%）手术被中止。手术中止的主要原因是胆管或血管解剖异常（7 例）、肝质量不佳（3 例）或术中出现意外情况（2 例）。在中位随访 23 个月期间，无中止供体手术的患者出现长期并发症。本报告专门关注一个重要问题：在一个大型北美 LDLT 中心，无法进行手术的决定的频率和原因。在不影响供体安全的情况下，应尽可能降低无法进行供体肝切除术的比率——然而，即使进行了严格的术前评估，供体中止的比率仍会很高。如果发现意外情况使供体面临更高的风险，应始终默认中止供体手术。
