AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
Am J Transplant. 2011 Apr;11(4):759-66. doi: 10.1111/j.1600-6143.2011.03477.x.
Although domino liver transplantation (LT) is an established procedure, data about the operative risks are limited. This study aimed at evaluating the operative risks of domino LT. Two retrospective analyses were conducted (comparison of familial amyloid polyneuropathy [FAP] liver donors [61 patients] vs. FAP nondonors [39 patients] and FAP liver recipients [61 patients] vs. deceased donor liver recipients [61 patients]). First analysis showed a 60-day mortality of 6.6% for FAP donors and 7.7% for FAP nondonors (p = 1.0). No patient developed primary graft nonfunction. Acute rejection was higher in FAP nondonors compared to FAP donors (38.5% vs. 13.1%). Both groups had similar vascular and biliary complication rates. ICU stay was similar, whereas total hospitalization was longer for FAP nondonors. Both groups had similar 1- and 5-year patient and graft survival rates (83.4% vs. 87.2%, and 79.8% vs. 71.8%, p = 0.7) and (83.3% vs. 87.2%, and 79.1% vs.71.8%, p = 0.7). The second analysis showed a 1.6% mortality for FAP liver recipients vs. 3.2% of the control group (p = 1). Both groups had similar morbidity and technical complication rates (18.0% vs. 13.1%, p = 0.45) and (0.18 vs. 0.15, p = 0.65). The domino procedure does not add any risk to FAP donor or recipient. It increases the organ pool allowing transplantation of marginal recipients who otherwise are denied deceased donor liver transplantation.
尽管多米诺肝移植（LT）是一种已确立的程序，但关于手术风险的数据有限。本研究旨在评估多米诺 LT 的手术风险。进行了两项回顾性分析（比较家族性淀粉样多神经病（FAP）肝供体[61 例]与 FAP 非供体[39 例]和 FAP 肝受者[61 例]与已故供体肝受者[61 例]）。第一项分析显示，FAP 供体的 60 天死亡率为 6.6%，FAP 非供体为 7.7%（p=1.0）。没有患者发生原发性移植物无功能。FAP 非供体的急性排斥反应高于 FAP 供体（38.5%对 13.1%）。两组的血管和胆道并发症发生率相似。重症监护病房的住院时间相似，但 FAP 非供体的总住院时间较长。两组的 1 年和 5 年患者和移植物存活率相似（83.4%对 87.2%和 79.8%对 71.8%，p=0.7）和（83.3%对 87.2%和 79.1%对 71.8%，p=0.7）。第二项分析显示，FAP 肝受者的死亡率为 1.6%，对照组为 3.2%（p=1）。两组的发病率和技术并发症发生率相似（18.0%对 13.1%，p=0.45）和（0.18 对 0.15，p=0.65）。多米诺程序不会给 FAP 供体或受者带来任何风险。它增加了器官库，允许移植否则会被拒绝接受已故供体肝移植的边缘受者。
