Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania, USA.
Clin Transplant. 2022 Jun;36(6):e14690. doi: 10.1111/ctr.14690. Epub 2022 May 3.
Living donor liver transplantation was first developed to mitigate the limited access to deceased donor organs in Asia in the 1990s. This alternative liver transplantation method has become a widely practiced and established transplantation option for adult patients suffering with end-stage liver disease, and it has successfully helped address the shortage of deceased donors. The Society for the Advancement of Transplant Anesthesia and the Korean Society of Transplantation Anesthesiologists jointly reviewed published studies on the perioperative management of adult live liver donors undergoing donor hemi-hepatectomy. The goal of the review is to offer transplant anesthesiologists and critical care physicians a comprehensive overview of the perioperative management of adult live donors. We featured the current status, donor selection process, outcomes and complications, surgical procedure, anesthetic management, Enhanced Recovery After Surgery protocols, avoidance of blood transfusion, and considerations for emergency donation. Recent surgical advances, including laparoscopic donor hemi-hepatectomy and robotic laparoscopic donor surgery, are also addressed.
活体肝移植最初是为了缓解 20 世纪 90 年代亚洲可供移植的已故供体器官数量有限的问题而开发的。这种替代的肝移植方法已成为治疗终末期肝病成年患者的广泛应用和成熟的移植选择,成功解决了已故供体的短缺问题。推进移植麻醉学会和韩国移植麻醉医师学会联合审查了关于接受供体半肝切除术的成人活体供肝者围手术期管理的已发表研究。该综述的目的是为移植麻醉师和重症监护医师提供成人活体供者围手术期管理的全面概述。我们重点介绍了当前的状况、供者选择过程、结果和并发症、手术过程、麻醉管理、手术后加速康复方案、避免输血以及紧急供肝的考虑因素。最近的手术进展,包括腹腔镜供体半肝切除术和机器人腹腔镜供体手术,也得到了阐述。