Vargas Paola A, Khanmammadova Narmina, Balci Deniz, Goldaracena Nicolas
Department of Surgery, Division of Transplantation, University of Virginia Health System, Charlottesville, VA, USA.
Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey.
Transplant Rev (Orlando). 2023 Jan;37(1):100750. doi: 10.1016/j.trre.2023.100750. Epub 2023 Feb 27.
Living Donor Liver Transplantation (LDLT) emerged as an alternative treatment option for patients with end-stage liver disease waiting for an organ from a deceased donor. In addition to allowing for a faster access to transplantation, LDLT provides improved recipient outcomes when compared to deceased donor LT. However, it represents a more complex and demanding procedure for the transplant surgeon. In addition to a comprehensive preoperative donor assessment and stringent technical considerations during the donor hepatectomy to ensure upmost donor safety, the recipient procedure also comes with intrinsic challenges during LDLT. A proper approach during both procedures will result in favorable donor and recipient's outcomes. Hence, it is critical for the transplant surgeon to know how to overcome such technical challenges and avoid deleterious complications. One of the most feared complications following LDLT is small-for-size syndrome (SFSS). Although, surgical advances and deeper understanding of the pathophysiology behind SFSS has allowed for a safer implementation of LDLT, there is currently no consensus on the best strategy to prevent or manage this complication. Therefore, we aim to review current practices in technically challenging situations during LDLT, with a particular focus on management of small grafts and venous outflow reconstructions, as they possess one of the biggest technical challenges faced during LDLT.
活体肝移植（LDLT）成为终末期肝病患者等待尸体供肝时的一种替代治疗选择。除了能更快地进行移植外，与尸体供肝肝移植相比，LDLT能改善受体的预后。然而，对于移植外科医生来说，它是一个更复杂、要求更高的手术。除了全面的术前供体评估以及在供体肝切除术中严格的技术考量以确保供体的最大安全外，受体手术在LDLT过程中也存在内在挑战。在这两个手术过程中采取正确的方法将带来良好的供体和受体预后。因此，移植外科医生了解如何克服此类技术挑战并避免有害并发症至关重要。LDLT后最可怕的并发症之一是小肝综合征（SFSS）。尽管手术进展以及对SFSS背后病理生理学的更深入理解使得LDLT的实施更安全，但目前对于预防或处理这一并发症的最佳策略尚无共识。因此，我们旨在回顾LDLT过程中技术难题情况下的当前做法，特别关注小移植物的管理和静脉流出道重建，因为它们是LDLT过程中面临的最大技术挑战之一。
