Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Transplantation. 2010 May 27;89(10):1276-82. doi: 10.1097/TP.0b013e3181d66c55.
Complications occur in a considerable proportion of living donors for liver transplantation. In this study, the surgery-related morbidity in living donors for more than 1000 liver transplantations was investigated.
The donor morbidity between June 1990 and August 2007 was analyzed retrospectively and classified by the graft type and time period. The complication severity was graded using the Clavien scoring system.
During the study period, 1262 living donors underwent donor operations for liver transplantation. The donors were divided into two groups by the graft type: group RG (n=500), comprising right and extended right lobe grafts, and group LG (n=762), comprising non-right lobe grafts. The overall complication rate was significantly higher in group RG than that in group LG (44.2% vs. 18.8%, P<0.05). The complication severity was worse in group RG than in group LG. Although biliary complications were the most common complications in both the groups, the frequencies differed significantly (RG: 12.2% vs. LG: 4.9%; P<0.05). Short-term complications (within 4 weeks after the donor operation) occurred in 308 donors (24.4% of all donors). Complications after 4 weeks occurred in only 17 donors. Donor age, right lobe donation, and prolonged operation time were found to be independent risk factors for complications by multivariate analyses.
Biliary complications were the most common and feared complications in living donors. There were more frequent and severe complications for right and extended right lobe donation than for non-right lobe donation. The possible risks of donor morbidity for different graft types should be understood and carefully considered.
在相当一部分肝移植的活体供者中会出现并发症。本研究调查了超过 1000 例肝移植活体供者的与手术相关的发病率。
回顾性分析 1990 年 6 月至 2007 年 8 月期间的供者发病率，并按移植物类型和时间段进行分类。使用 Clavien 评分系统对并发症严重程度进行分级。
在研究期间，1262 名活体供者接受了肝移植供者手术。供者按移植物类型分为两组：RG 组（n=500），包括右叶和扩大右叶移植物；LG 组（n=762），包括非右叶移植物。RG 组的总并发症发生率明显高于 LG 组（44.2%比 18.8%，P<0.05）。RG 组的并发症严重程度较 LG 组差。尽管两组的主要并发症都是胆道并发症，但频率差异有统计学意义（RG：12.2%比 LG：4.9%；P<0.05）。308 名供者（所有供者的 24.4%）在供者手术后 4 周内出现短期并发症。仅 17 名供者在 4 周后出现并发症。多变量分析显示，供者年龄、右叶捐献和手术时间延长是并发症的独立危险因素。
胆道并发症是活体供者最常见和最令人担忧的并发症。右叶和扩大右叶供肝比非右叶供肝更容易发生更频繁和更严重的并发症。应了解并仔细考虑不同移植物类型供者发病的可能风险。
