Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
Division of Abdominal Transplant Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA.
Curr Opin Organ Transplant. 2019 Apr;24(2):131-137. doi: 10.1097/MOT.0000000000000610.
As experience grows, living donor liver transplantation (LDLT) has become an effective treatment option to overcome the deceased donor organ shortage.
Donor safety is the highest priority in LDLT. Strict donor selection according to structured protocols and center experience are the main factors that determine donor safety. However, with increased experience, many centers have explored increasing organ availability within living donation by means of ABO incompatible LDLT, dual graft LDLT, and anonymous living donation. Also, this growing experience in LDLT has allowed the transplant community to cautiously explore the role of liver transplantation for hepatocellular carcinoma outside of Milan criteria and patients with unresectable colorectal liver metastases.
LDLT has become established as a viable strategy to ameliorate the organ shortage experienced by centers around the world. Improved understanding of this technique has allowed the improved utilization of live donor graft resources, without compromising donor safety. Moreover, LDLT may offer some advantages over deceased donor liver transplantation and a unique opportunity to assess the broader applicability of liver transplantation.
随着经验的积累,活体供肝移植(LDLT)已成为克服已故供体器官短缺的有效治疗选择。
供体安全是 LDLT 的重中之重。根据结构化方案和中心经验进行严格的供体选择是决定供体安全的主要因素。然而,随着经验的增加,许多中心已经探索了通过 ABO 不相容 LDLT、双移植物 LDLT 和匿名活体供肝来增加活体供肝的器官可用性。此外,在 LDLT 方面的不断积累经验使移植界能够谨慎探索米兰标准以外的肝细胞癌和不可切除结直肠癌肝转移患者的肝移植作用。
LDLT 已成为改善全球中心器官短缺的可行策略。对该技术的深入了解使活体供者移植物资源的利用得到了改善,同时又不影响供者的安全。此外,LDLT 可能比已故供体肝移植具有一些优势,并为评估肝移植的更广泛适用性提供了独特的机会。