De Carlis Riccardo, Di Lucca Gabriele, Lauterio Andrea, Centonze Leonardo, De Carlis Luciano
PhD Course in Clinical and Experimental Sciences, University of Padua, Via 8 Febbraio, 235122, Padua, Italy.
Department of General Surgery and Transplantation, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Updates Surg. 2024 Jun 26. doi: 10.1007/s13304-024-01894-4.
Living donor liver transplantation (LDLT) has been proposed in many countries to reduce organ shortage. While the early postoperative outcomes have been well investigated, little is known about the long-term follow-up of the living donors. We, therefore, designed a systematic review of the literature to explore long-term complications and quality of life among living donors. We searched MEDLINE and EMBASE registries for studies published since 2013 that specifically addressed long-term follow-up following living-donor liver donation, concerning both physical and psychological aspects. Publications with a follow-up shorter than 1 year or that did not clearly state the timing of outcomes were excluded. A total of 2505 papers were initially identified. After a thorough selection, 17 articles were identified as meeting the eligibility criteria. The selected articles were mostly from North America and Eastern countries. Follow-up periods ranged from 1 to 11.5 years. The most common complications were incision site discomfort (13.2-38.8%) and psychiatric disorders (1-22%). Biliary strictures occurred in 1-14% of cases. Minimally invasive donor hepatectomy could improve quality of life, but long-term data are limited. About 30 years after the first reported LDLT, little has been published about the long-term follow-up of the living donors. Different factors may contribute to this gap, including the fact that, as healthy individuals, living donors are frequently lost during mid-term follow-up. Although the reported studies seem to confirm long-term donor safety, further research is needed to address the real-life long-term impact of this procedure.
许多国家已提出开展活体肝移植（LDLT）以缓解器官短缺问题。虽然术后早期结局已得到充分研究，但对于活体供体的长期随访情况却知之甚少。因此，我们设计了一项系统文献综述，以探讨活体供体的长期并发症及生活质量。我们在MEDLINE和EMBASE数据库中检索了自2013年以来发表的专门针对活体肝移植后长期随访的研究，涉及身体和心理方面。随访时间短于1年或未明确说明结局时间的出版物被排除。初步共识别出2505篇论文。经过全面筛选，确定有17篇文章符合纳入标准。所选文章大多来自北美和东方国家。随访期为1至11.5年。最常见的并发症是切口部位不适（13.2 - 38.8%）和精神障碍（1 - 22%）。1 - 14%的病例发生胆管狭窄。微创供体肝切除术可改善生活质量，但长期数据有限。在首次报道活体肝移植约30年后，关于活体供体长期随访的报道很少。不同因素可能导致了这一差距，包括作为健康个体的活体供体在中期随访期间经常失访这一事实。尽管已报道的研究似乎证实了供体的长期安全性，但仍需要进一步研究以解决该手术对现实生活的长期影响。
