Dew M A, Butt Z, Humar A, DiMartini A F
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
Department of Psychology, University of Pittsburgh, Pittsburgh, PA.
Am J Transplant. 2017 Apr;17(4):880-892. doi: 10.1111/ajt.14111. Epub 2016 Dec 22.
Due to the enduring organ shortage, living donor liver transplantation has been a valuable treatment strategy for advanced liver disease patients for over 20 years. A variety of reviews have summarized the extensive data now available on medical and psychosocial risks to living donors in the aftermath of donation. However, evidence on donor medical and psychosocial outcomes beyond the first year postdonation has not been synthesized in any previous review. The evidence base on such "long-term" outcomes has been growing in recent years. A review of this evidence would therefore be timely and could serve as an important resource to assist transplant centers in their efforts to fully educate prospective donors and gain informed consent, as well as develop appropriate postdonation clinical care and surveillance plans. We reviewed recent literature on long-term donor outcomes, considering (a) medical outcomes, including mortality risk, rates of complications, abnormalities detected in laboratory testing, and the progress of liver regeneration; and (b) donor-reported psychosocial outcomes reflecting physical, emotional, and interpersonal/socioeconomic well-being, as well as overall health-related quality of life. We summarize limitations and gaps in available evidence, and we provide recommendations for future research and clinical care activities focused on long-term outcomes in liver donors.
由于长期存在器官短缺问题，活体肝移植在20多年来一直是晚期肝病患者的一种重要治疗策略。各种综述总结了目前大量关于捐赠后活体供体医学和心理社会风险的数据。然而，以往的任何综述都没有综合捐赠后第一年以外的供体医学和心理社会结局的证据。近年来，关于此类“长期”结局的证据基础一直在不断扩大。因此，对这一证据进行综述将是及时的，并且可以作为一项重要资源，帮助移植中心努力对潜在供体进行充分教育并获得知情同意，以及制定适当的捐赠后临床护理和监测计划。我们回顾了近期关于供体长期结局的文献，考虑了：（a）医学结局，包括死亡风险、并发症发生率、实验室检查中发现的异常以及肝脏再生进展；（b）供体报告的心理社会结局，反映身体、情感以及人际/社会经济福祉，以及整体健康相关生活质量。我们总结了现有证据中的局限性和差距，并针对未来聚焦于肝供体长期结局的研究和临床护理活动提出建议。
