Moon D-B, Lee S-G, Hwang S, Kim K-H, Ahn C-S, Ha T-Y, Song G-W, Jung D-H, Park G-C, Namkoong J-M, Park H-W, Park Y-H, Park C-S
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2013 Jun;45(5):1942-7. doi: 10.1016/j.transproceed.2013.02.041.
Living donor liver transplantation (LDLT) has been the first option for the patients requiring liver transplantation in East Asia because of the scarcity of cadaveric grafts. We have performed consecutively more than 300 LDLTs per year, and herein report our methods.
In 1997, the first successful adult LDLTs used a left and subsequently a right lobe. However, congestion in the anterior segment of right-lobe grafts prompted us to initiate reconstruction of middle hepatic venous tributaries in 1998. Dual LDLT grafts using 2 left lobes were developed in 2000 to solve graft-size insufficiency and minimize donor risk. The indications for adult LDLT were broadened to near complete obstruction of the portal vein by application of intraoperative cine-portography and portal vein stenting in 2004. ABO-incompatible adult LDLT was initiated in 2008 to overcome the blood group barrier between recipient and donor.
With various innovations at our institution, 317 LDLTs were performed yearly in 2010 and 2011: 301 in 2010 and 298 in 2011. The most common primary diseases was hepatitis B virus-related liver cirrhosis with or without hepatocellular carcinoma (64.3%). The most common graft types were right hemiliver (82.6%). There has been no donor mortality. ABO-incompatible LDLT cases were 11.0% of the total. In-hospital mortality in 2011 was 2.5% (n = 8; adult 6, pediatric 2).
Innovations in operative techniques and perioperative care as well as dedicated team members have made it possible to perform more than 300 LDLTs per year consecutively with excellent outcomes.
由于尸体供肝稀缺，活体肝移植（LDLT）已成为东亚地区需要肝移植患者的首选方案。我们每年连续开展300多例LDLT手术，在此报告我们的方法。
1997年，首例成功的成人LDLT采用左叶供肝，随后采用右叶供肝。然而，右叶移植肝前段的淤血促使我们在1998年开始重建肝中静脉分支。2000年开发了使用2个左叶的双供肝LDLT，以解决供肝体积不足问题并将供者风险降至最低。2004年，通过术中门静脉造影和门静脉支架置入术，将成人LDLT的适应证扩大到门静脉几乎完全阻塞的情况。2008年开始开展ABO血型不相容的成人LDLT，以克服受者与供者之间的血型障碍。
通过我们机构的各种创新，2010年和2011年每年进行317例LDLT手术：2010年为301例，2011年为298例。最常见的原发性疾病是乙型肝炎病毒相关肝硬化伴或不伴肝细胞癌（64.3%）。最常见的供肝类型是右半肝（82.6%）。无供者死亡。ABO血型不相容的LDLT病例占总数的11.0%。2011年的住院死亡率为2.5%（n = 8；成人6例，儿童2例）。
手术技术和围手术期护理的创新以及专业的团队成员使得每年能够连续进行300多例LDLT手术，并取得了优异的效果。
