Magyar Christian Tibor Josef, Choi Woo Jin, Li Zhihao, Cattral Mark Steven, Selzner Nazia, Ghanekar Anand, Sayed Blayne Amir, Sapisochin Gonzalo
Department of Surgery, University of Toronto, Toronto, ON, Canada.
HBP and Multi Organ Transplant Program, Division of General Surgery, University Health Network, HPB Surgical Oncology, Toronto, ON, Canada.
Updates Surg. 2024 Jun 25. doi: 10.1007/s13304-024-01881-9.
Living liver donation (LLD) has been suggested as a potential solution to reduce the waitlist mortality for liver transplantation (LT) recipients by facilitating living donor liver transplantation (LDLT). Ensuring both donor and recipient safety is a critical aspect of LDLT. An accurate understanding of the complexity and extend of safety outcomes of the donor is imperative to maintain the high-quality standard this medical program requires. This review seeks to outline safety outcome parameters of interest for donors. Early postoperative mortality is very low with no significant differences comparing left lobe to right lobe LLD. Complications most commonly are biliary (leakage or strictures), bleeding, respiratory or pulmonary, gastrointestinal or infectious. Return to full-time work and quality of life are essential parameters in the mid and long term. As evidence continues to accumulate, outcomes may evolve with the expansion of minimal invasive surgery practice and currently laparoscopic approach is recommended in large experienced centers. By offering safer operations that require fewer incisions or liver resections, living liver donations can be further encouraged, and the perception of the procedure can be improved. Rational consideration of the safety of the donor and in-depth discussion and evaluation with the patient is of utmost importance.
活体肝移植（LLD）被认为是一种潜在的解决方案，通过促进活体供肝肝移植（LDLT）来降低肝移植（LT）受者的等待名单死亡率。确保供体和受体的安全是LDLT的一个关键方面。准确了解供体安全结果的复杂性和范围对于维持该医疗项目所需的高质量标准至关重要。本综述旨在概述供体关注的安全结果参数。术后早期死亡率非常低，左叶与右叶LLD相比无显著差异。最常见的并发症是胆道（渗漏或狭窄）、出血、呼吸或肺部、胃肠道或感染性并发症。中长期来看，恢复全职工作和生活质量是重要参数。随着证据不断积累，随着微创手术实践的扩大，结果可能会有所变化，目前大型经验丰富的中心推荐采用腹腔镜方法。通过提供更安全、切口或肝切除更少的手术，可以进一步鼓励活体肝捐赠，并改善对该手术的看法。合理考虑供体的安全性并与患者进行深入的讨论和评估至关重要。
