Ates M, Hatipoglu S, Dirican A, Isik B, Ince V, Yilmaz M, Aydin C, Ara C, Kayaalp C, Yilmaz S
Department of General Surgery, Inonu University, School of Medicine, Malatya, Turkey.
Transplant Proc. 2013 Jun;45(5):1948-52. doi: 10.1016/j.transproceed.2012.10.056.
Right-lobe living-donor liver transplantation (RLDLT) is an excellent option to reduce donor shortages for adult patients with acute liver failure (ALF). The aim of this study was to evaluate the etiologies and outcomes of 30 consecutive adult patients who underwent emergency RLDLT for ALF.
Between January 2007 and September 2011, we examined data from medical records of patients with ALF who underwent RLDLT.
Their mean age was 32.2 ± 13.05 years. The etiologies of ALF were acute hepatitis B (n = 11; 36.6%), hepatitis A (n = 4; 13.3%), drug intoxication (n = 4; 13.3%), pregnancy (n = 2; 6.7%), hepatitis B with pregnancy (n = 1; 3.3%), mushroom intoxication (n = 1; 3.3%), and unknown (n = 7; 23.3%). The mean hepatic coma grade (Model for End-Stage Liver Disease score) was 34.13 ± 8.72. The 43 (48.7%) postoperative complications were minor (grades I-II) and 44 (51.3%) were major (grades III-V). Reoperation was required in 14 of 30 (47%) recipients (grades IIIb-IVa). Deaths occurred owing to pulmonary (n = 2), cardiac (n = 1), septic (n = 2), or encephalopathic (n = 4) complications. The mean durations of intensive care unit stay and postoperative hospitalization were 3.2 ± 2.3 and 29.5 ± 23 days, respectively. The survival rate was 70%. The mean follow-up duration was 305 days (range, 1-1582).
Liver transplantation is potentially the only curative modality, markedly improving the prognosis of patients with ALF. The interval between ALF onset and death is short and crucial because of the rapid, progressive multiorgan failure. Thus, RLDLT should be considered to be a life-saving procedure for adult patients with ALF, requiring quicker access to a deceased-donor liver graft and a short ischemia time.
右叶活体肝移植（RLDLT）是减少成年急性肝衰竭（ALF）患者供体短缺的理想选择。本研究旨在评估30例连续接受急诊RLDLT治疗ALF的成年患者的病因及预后。
2007年1月至2011年9月期间，我们查阅了接受RLDLT的ALF患者的病历资料。
他们的平均年龄为32.2±13.05岁。ALF的病因包括急性乙型肝炎（n = 11；36.6%）、甲型肝炎（n = 4；13.3%）、药物中毒（n = 4；13.3%）、妊娠（n = 2；6.7%）、妊娠合并乙型肝炎（n = 1；3.3%）、蘑菇中毒（n = 1；3.3%）以及病因不明（n = 7；23.3%）。平均肝昏迷分级（终末期肝病模型评分）为34.13±8.72。术后并发症43例（48.7%）为轻度（I-II级），44例（51.3%）为重度（III-V级）。30例受者中有14例（47%）需要再次手术（IIIb-IVa级）。死亡原因包括肺部并发症（n = 2）、心脏并发症（n = 1）、感染性并发症（n = 2）或脑病并发症（n = 4）。重症监护病房停留时间和术后住院时间的平均值分别为3.2±2.3天和29.5±23天。生存率为70%。平均随访时间为305天（范围1-1582天）。
肝移植可能是唯一的治愈方式，可显著改善ALF患者的预后。由于快速进展的多器官功能衰竭，ALF发病至死亡的间隔时间短且至关重要。因此，RLDLT应被视为成年ALF患者的救命手术，需要更快地获得尸体供肝移植且缺血时间短。
