Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2021 Jan-Feb;53(1):83-91. doi: 10.1016/j.transproceed.2020.08.027. Epub 2020 Oct 1.
More than 400 liver transplants were performed at Asan Medical Center (AMC) in 2011, and over 500 liver transplants including 420 living-donor liver transplants (LDLTs) were performed in 2019. Herein, we report the methodology of these procedures.
Since the first adult LDLTs at AMC using the left and right lobes were successfully performed, various innovative techniques and approaches have been developed: modified right lobe, dual graft, donor exchange for ABO incompatibility, expansion of indications and no-touch techniques for hepatocellular carcinoma, intraoperative cine-portogram and additional intervention for large collaterals, management of portal vein thrombosis (PVT) and stenosis, salvage LDLT after major hepatectomy, and timely LDLT for patients with acute-on-chronic liver failure.
Four hundred twenty LDLTs in 403 adult and 17 pediatric patients and 85 deceased-donor liver transplants in 74 adult and 11 pediatric patients were performed. The number of deceased-donor liver transplants remained constant since 2011, but the number of LDLTs increased steadily. One hundred thirty patients (25.7%) required urgent liver transplantations and 24 patients with acute-on-chronic liver failure underwent LDLT. PVT including grade 1,2,3, and 4 was reported in 91 patients (18.0%), and Yerdel's grade 2, 3, and 4 PVT was reported in 47 patients (51.6%); all patients with PVT were successfully treated. Adult LDLTs for hepatocellular carcinoma and ABO incompatibility accounted for 52.6% and 24.3% of the cases, respectively. In-hospital mortality in 2019 was 2.97%.
Continual efforts to overcome challenging problems in LDLT with various innovations and dedication of the team members during the perioperative period to improve patient outcomes were crucial in increasing the number of liver transplantations at Asan Medical Center.
2011 年，Asan 医疗中心（AMC）完成了超过 400 例肝移植手术，2019 年完成了超过 500 例肝移植手术，包括 420 例活体供肝肝移植（LDLT）。在此，我们报告这些手术的方法。
自 AMC 首例成人左、右叶活体供肝肝移植成功以来，已开发出各种创新技术和方法：改良右叶、双移植物、ABO 不相容供体交换、扩大适应证和无接触技术治疗肝细胞癌、术中 cine-portogram 和大型侧支的额外干预、门静脉血栓形成（PVT）和狭窄的处理、大肝切除术后挽救性 LDLT 以及急性肝衰竭患者的及时 LDLT。
在 403 例成人和 17 例儿科患者中进行了 420 例 LDLT，在 74 例成人和 11 例儿科患者中进行了 85 例尸肝移植。自 2011 年以来，尸肝移植数量保持不变，但 LDLT 数量稳步增加。130 例（25.7%）需要紧急肝移植，24 例急性肝衰竭患者接受 LDLT。91 例（18.0%）患者报告存在 PVT，包括 1 级、2 级、3 级和 4 级，47 例（51.6%）患者报告存在 Yerdel 2 级、3 级和 4 级 PVT；所有 PVT 患者均得到成功治疗。成人 LDLT 治疗肝细胞癌和 ABO 不相容的比例分别为 52.6%和 24.3%。2019 年住院死亡率为 2.97%。
通过各种创新不断努力克服 LDLT 中的挑战性问题，以及团队成员在围手术期的奉献精神，对于增加 Asan 医疗中心的肝移植数量至关重要。
