Yankol Yücel, Mecit Nesimi, Kanmaz Turan, Kalayoğlu Münci, Acarlı Koray
Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.
Department of Surgery Division of Transplantation, University of Wisconsin, Madison, WI, United States of America.
Turk J Surg. 2020 Jun 8;36(2):192-201. doi: 10.5578/turkjsurg.4548. eCollection 2020 Jun.
Living liver donor surgery is a major surgical procedure applied to healthy people with mortality and morbidity risks and does not provide any direct therapeutic advantage to the donor. We retrospectively analyzed the postoperative complication of our living liver donors to figure out the risks of donation.
Between November, 2006 and December, 2018, a total of 939 living liver donor hepatectomies were performed with no mortality to the living-related donors. Eight hundred and ninety donors with a minimum 1-year follow-up were analyzed retrospectively.
Of the 890 donors, 519 (58.3%) were males and 371 (41.7%) were females. Mean age was 35 years (18-64) and mean body mass index was 25.7 kg/m (17.7-40). Right donor hepatectomy was performed to 601 (67.5%), left donor hepatectomy to 28 (3.2%) and left lateral sector hepatectomy to 261 (29.3%) of the donors. Of the 890 donors, 174 (19.5%) donors experienced a total of 204 early and late complications including life- threatening and nearly life- threatening complications in 26 (2.9%) of them. Intraoperative complication occurred in 4 (0.5%) donors. Right donors hepatectomy complication rate (23.3%) was higher than left donor (14.3%) and left lateral sector donor hepatectomy (11.5%).
All donor candidates should be well-informed not only on the details of early and late complications of living liver donation, also possible outcomes of the recipient. In addition to detailed physical evaluation, preoperative psychosocial evaluation is also mandatory. Comprehensive donor evaluation, surgical experience, surgical technique, close postoperative follow-up and establishing a good dialog with the donor allows better outcomes.
活体肝供体手术是一项针对健康人的重大外科手术,存在死亡和发病风险,且对供体没有任何直接的治疗益处。我们回顾性分析了我们的活体肝供体的术后并发症,以明确捐献的风险。
2006年11月至2018年12月期间,共进行了939例活体肝供体肝切除术,对活体亲属供体无死亡情况。对890例至少随访1年的供体进行回顾性分析。
在890例供体中,519例(58.3%)为男性,371例(41.7%)为女性。平均年龄为35岁(18 - 64岁),平均体重指数为25.7 kg/m²(17.7 - 40)。601例(67.5%)供体进行了右半肝切除术,28例(3.2%)进行了左半肝切除术,261例(29.3%)进行了左外叶肝切除术。在890例供体中,174例(19.5%)供体共经历了204例早期和晚期并发症,其中26例(2.9%)发生了危及生命和近乎危及生命的并发症。4例(0.5%)供体发生术中并发症。右半肝切除术的并发症发生率(23.3%)高于左半肝切除术(14.3%)和左外叶肝切除术(11.5%)。
所有供体候选人不仅应充分了解活体肝捐献早期和晚期并发症的细节,还应了解受体可能的结果。除了详细的体格检查外,术前心理社会评估也是必需的。全面的供体评估、手术经验、手术技术、术后密切随访以及与供体建立良好的沟通可带来更好的结果。