Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
J Intensive Care Med. 2012 Mar-Apr;27(2):71-8. doi: 10.1177/0885066610394313. Epub 2011 Jan 10.
A perception that living donor liver transplantation can be accomplished with an acceptable donor complication rate and recipient survival rate has led to the acceptance of living donor liver transplantation as a viable alternative to decreased deceased donor transplantation. Careful candidate evaluation and selection has been crucial to the success of this procedure. Advancements in the understanding of the lobar nature of the liver and of liver regeneration have advanced the surgical technique. Initial attempts at adult-to-adult donation utilized the left hepatic lobe, but now have evolved into use of the right hepatic lobe. Size matching is very important to successful graft function in the recipient. There is great concern regarding morbidity and mortality in donors. Biliary complications and infections continue to be among the most highly reported complications, although rates vary among centers and countries. Reports of single center complications have ranged from 9% to 67%. A survey of centers in the United States in 2003 reported complications of 10%. A series from our institution reported complications arising in 13 (33%) of 39 patients. A review focused on documenting donor deaths found 33 living liver donor deaths worldwide. The much publicized immediate postoperative mishap of 2002 that resulted in a donor's death resulted in a drop in the utilization of living donor liver transplantation in the United States, from which this procedure has never fully recovered. The future development and expansion of living donor liver transplantation depends on open communication regarding donor complications and deaths. Close immediate postoperative monitoring and meticulous management will remain an essential aspect in limiting donor complications and deaths.
人们认为活体肝移植可以以可接受的供体并发症发生率和受体存活率来完成，这使得活体肝移植成为降低已故供体移植的可行替代方法。对候选者进行仔细的评估和选择是该手术成功的关键。对肝脏叶状结构和肝脏再生的理解的进步促进了手术技术的发展。成人对成人供体的最初尝试使用了左肝叶，但现在已发展为使用右肝叶。大小匹配对于受体成功移植非常重要。供体的发病率和死亡率令人非常担忧。胆道并发症和感染仍然是报告最多的并发症之一，尽管各中心和国家的报告率不同。一些中心报告的并发症发生率从 9%到 67%不等。2003 年对美国中心的一项调查报告称，并发症发生率为 10%。我们机构的一系列报告显示，39 名患者中有 13 名（33%）出现并发症。一项集中记录供体死亡的综述发现，全球有 33 名活体肝移植供体死亡。2002 年发生的一起广为人知的术后即刻并发症事件导致一名供体死亡，这导致美国活体肝移植的使用率下降，此后该手术一直未能完全恢复。活体肝移植的未来发展和扩大取决于对供体并发症和死亡的公开沟通。密切的术后即时监测和细致的管理将仍然是限制供体并发症和死亡的重要方面。
