Medanta Institute of Liver Transplantation, Haryana, India.
Division of Transplantation, University of Colorado Anschutz Medical Campus, Aurora, CO.
Transplantation. 2019 Feb;103(2):e39-e47. doi: 10.1097/TP.0000000000002475.
Although surgical technique in living donor liver transplantation (LDLT) has evolved with a focus on donor safety and recipient challenges, the donor selection criteria remain considerably disparate.
A questionnaire on donor selection was sent to 41 centers worldwide. 24 centers with a combined experience of 19 009 LDLTs responded.
Centers were categorized into predominantly LDLT (18) or deceased donor liver transplantation (6), and high- (10) or low-volume (14) centers. At most centers, the minimum acceptable graft-to-recipient weight ratio was 0.7 or less (67%), and remnant was 30% (75%). The median upper limit of donor age was 60 years and body mass index of 33 kg/m. At 63% centers, age influenced the upper limit of body mass index inversely. Majority preferred aspartate transaminase and alanine transaminase less than 50 IU/mL. Most accepted donors with nondebilitating mild mental or physical disability and rejected donors with treated coronary artery disease, cerebrovascular accident and nonbrain, nonskin primary malignancies. Opinions were divided about previous psychiatric illness, substance abuse and abdominal surgery. Most performed selective liver biopsy, commonly for steatosis, raised transaminases and 1 or more features of metabolic syndrome. On biopsy, all considered macrovesicular and 50% considered microvesicular steatosis important. Nearly all (92%) rejected donors for early fibrosis, and minority for nonspecific granuloma or mild inflammation. Most anatomical anomalies except portal vein type D/E were acceptable at high-volume centers. There was no standard policy for preoperative or peroperative cholangiogram.
This first large live liver donor survey provides insight into donor selection practices that may aid standardization between centers, with potential expansion of the donor pool without compromising safety.
尽管活体肝移植（LDLT）的手术技术已经发展，重点是确保供者安全和解决受者的挑战，但供者选择标准仍有很大差异。
我们向全球 41 个中心发送了一份关于供者选择的问卷。24 个中心回复了，这些中心共进行了 19009 例 LDLT。
根据主要进行 LDLT（18 个）或脑死亡供肝移植（6 个）、高容量（10 个）或低容量（14 个）中心对这些中心进行分类。在大多数中心，可接受的最小移植物与受者体重比为 0.7 或更低（67%），残留肝体积为 30%（75%）。供者年龄的中位数上限为 60 岁，体重指数为 33kg/m2。在 63%的中心，年龄会使体重指数的上限值呈反比增加。大多数中心将天冬氨酸转氨酶和丙氨酸转氨酶小于 50IU/mL 作为可接受标准。大多数中心接受有非致残性轻微精神或身体残疾的供者，拒绝有治疗过的冠状动脉疾病、脑血管意外、非脑非皮肤原发性恶性肿瘤的供者。对于既往精神病史、药物滥用和腹部手术，意见不一。大多数中心进行选择性肝活检，通常用于检查脂肪变性、转氨酶升高和 1 种或多种代谢综合征的特征。在活检中，所有人都认为巨泡性和 50%的微泡性脂肪变性很重要。几乎所有（92%）中心都拒绝有早期纤维化的供者，少数中心拒绝有非特异性肉芽肿或轻度炎症的供者。除门静脉 D/E 型外，大多数解剖学异常在高容量中心都是可接受的。对于术前或术中胆管造影，没有标准的政策。
这项关于活体肝供者的首次大型调查提供了对供者选择实践的深入了解，这可能有助于中心之间的标准化，在不影响安全性的情况下扩大供者库。
