Neumann U P, Neuhaus P, Schmeding M
Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Universitätsklinikum Aachen der Rheinland-Westfälischen Technischen Hochschule, Deutschland.
Chirurg. 2010 Sep;81(9):804, 806-12. doi: 10.1007/s00104-009-1874-x.
The worldwide shortage of adequate donor organs implies that living donor liver transplantation represents a valuable alternative to cadaveric transplantation. In addition to the complex surgical procedure the correct identification of eligible donors and recipients plays a decisive role in living donor liver transplantation. Donor safety must be of ultimate priority and overrules all other aspects involved. In contrast to the slightly receding numbers in Europe and North America, in recent years Asian programs have enjoyed constantly increasing living donor activity. The experience of the past 15 years has clearly demonstrated that technical challenges of both bile duct anastomosis and venous outflow of the graft significantly influence postoperative outcome. While short-term in-hospital morbidity remains increased compared to cadaveric transplantation, long-term survival of both graft and patient are comparable or even better than in deceased donor transplantation. Especially for patients expecting long waiting times under the MELD allocation system, living donor liver transplantation offers an excellent therapeutic alternative. Expanding the so-called "Milan criteria" for HCC patients with the option for living donor liver transplantation is currently being controversially debated.
全球范围内供体器官的短缺意味着活体供肝移植是尸体供肝移植的一种宝贵替代方案。除了复杂的手术过程外，正确识别合适的供体和受体在活体供肝移植中起着决定性作用。供体安全必须是首要考虑因素，高于其他所有相关方面。与欧洲和北美的数量略有下降形成对比的是，近年来亚洲的活体供肝移植项目活动持续增加。过去15年的经验清楚地表明，胆管吻合和移植物静脉流出的技术挑战对术后结果有显著影响。虽然与尸体供肝移植相比，短期住院发病率仍然较高，但移植物和患者的长期生存率相当，甚至优于尸体供肝移植。特别是对于那些在终末期肝病模型（MELD）分配系统下预计等待时间较长的患者，活体供肝移植提供了一种极佳的治疗选择。目前，对于扩大肝癌患者的所谓“米兰标准”以选择活体供肝移植存在争议。
