Routh Dronacharya, Naidu Sudeep, Sharma Sanjay, Ranjan Priya, Godara Rajesh
Department of GI Surgery and Liver Transplantation, Army Hospital (R&R), New Delhi 110010, India.
Department of Surgery, Post Graduate Institute of Medical Sciences, Rhotak, Haryana, India.
J Clin Exp Hepatol. 2013 Dec;3(4):337-46. doi: 10.1016/j.jceh.2013.11.007. Epub 2013 Dec 5.
During the last couple of decades, with standardization and progress in surgical techniques, immunosuppression and post liver transplantation patient care, the outcome of liver transplantation has been optimized. However, the principal limitation of transplantation remains access to an allograft. The number of patients who could derive benefit from liver transplantation markedly exceeds the number of available deceased donors. The large gap between the growing list of patients waiting for liver transplantation and the scarcity of donor organs has fueled efforts to maximize existing donor pool and identify new avenues. This article reviews the changing pattern of donor for liver transplantation using grafts from extended criteria donors (elderly donors, steatotic donors, donors with malignancies, donors with viral hepatitis), donation after cardiac death, use of partial grafts (split liver grafts) and other suboptimal donors (hypernatremia, infections, hypotension and inotropic support).
在过去几十年间，随着外科技术、免疫抑制及肝移植术后患者护理的标准化和进步，肝移植的结果已得到优化。然而，移植的主要限制仍然是同种异体移植物的获取。能够从肝移植中获益的患者数量明显超过了可用的脑死亡供体数量。等待肝移植的患者名单不断增加与供体器官稀缺之间的巨大差距，促使人们努力最大限度地利用现有的供体库并寻找新途径。本文综述了肝移植供体模式的变化，包括使用边缘供体（老年供体、脂肪变性供体、恶性肿瘤供体、病毒性肝炎供体）的移植物、心脏死亡后捐献、部分移植物（劈裂肝移植物）的使用以及其他次优供体（高钠血症、感染、低血压和使用血管活性药物支持）。
