Connie Frank Transplant Center, Division of Abdominal Transplantation, University of California, San Francisco, California.
Department of Surgery, University of California, San Francisco, California.
Am J Transplant. 2019 Sep;19(9):2646-2649. doi: 10.1111/ajt.15386. Epub 2019 May 8.
Organ transplantation is the optimal treatment for patients with end stage liver disease and end stage renal disease. However, due to the imbalance in the demand and supply of deceased organs, most transplant centers worldwide have consciously pursued a strategy for living donation. Paired exchanges were introduced as a means to bypass various biologic incompatibilities (blood- and tissue-typing), while expanding the living donor pool. This shift in paradigm has introduced new ethical concerns that have hitherto been unaddressed, especially with nondirected, altruistic living donors. So far, transplant communities have focused efforts on separate liver- and kidney-paired exchanges, whereas the concept of a transorgan paired exchange has been theorized and could potentially facilitate a greater number of transplants. We describe the performance of the first successful liver-kidney swap.
器官移植是治疗终末期肝病和终末期肾病患者的最佳方法。然而，由于捐献器官的需求和供应之间存在不平衡，全球大多数移植中心都有意识地采取了活体捐赠策略。配对交换被引入作为一种绕过各种生物不相容性（血型和组织配型）的方法，同时扩大了活体供体库。这种范式的转变带来了新的尚未解决的伦理问题，尤其是对于非定向的、利他主义的活体供体。到目前为止，移植界的努力主要集中在单独的肝-肾配对交换上，而跨器官配对交换的概念已经被提出，并有可能促进更多的移植。我们描述了首例成功的肝-肾交换的实施情况。
