Emond Jean C, Di Sandro Stefano, Pomfret Elizabeth A
Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA.
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, MO, Italy.
Updates Surg. 2024 Sep 20. doi: 10.1007/s13304-024-01994-1.
Living donor liver transplantation (LDLT) was first performed in the US in 1989, primarily benefiting pediatric patients. Its adoption for adults faced setbacks after a donor death in 2001, causing widespread risk aversion. Despite ethical justification and demonstrated safety, LDLT remains underutilized, with fewer than 10% of liver transplants being LDLT. Recent trends indicate improved access to deceased donor liver transplantation (DDLT) due to increased organ donation and technological advances like Normothermic Regional Perfusion (NRP). However, LDLT remains critical, especially for pediatric patients and specific adult populations who benefit significantly from it. Barriers to LDLT include public and clinician apprehensions about donor risks, despite studies showing low-complication rates. Non-directed donations and broader social media engagement have increased donor pools, though the volume of LDLT in the US remains lower than in Asia due to limited training and experience. The A2ALL consortium has been pivotal in studying LDLT safety and outcomes. Currently, around 40 US centers perform LDLT, with high-volume centers leading by example. Training paradigms for LDLT are evolving, with initiatives like the ASTS LDLT master class aiming to enhance surgical expertise. While LDLT is embedded in US liver-transplant practices, its expansion is hampered by risk aversion and the availability of DDLT. Nonetheless, LDLT is essential for addressing the supply-demand mismatch in liver transplantation.
活体供肝移植（LDLT）于1989年在美国首次开展，主要惠及儿童患者。2001年一名供体死亡后，其在成人中的应用遭遇挫折，导致普遍的风险规避。尽管有伦理依据且已证明其安全性，但LDLT的利用率仍然很低，在肝移植中LDLT的比例不到10%。近期趋势表明，由于器官捐献增加以及诸如常温区域灌注（NRP）等技术进步， deceased donor liver transplantation（DDLT）的可及性有所改善。然而，LDLT仍然至关重要，特别是对于儿童患者和从中显著受益的特定成年人群体。LDLT的障碍包括公众和临床医生对供体风险的担忧，尽管研究表明并发症发生率较低。非定向捐赠和更广泛的社交媒体参与增加了供体库，不过由于培训和经验有限，美国的LDLT数量仍低于亚洲。A2ALL联盟在研究LDLT的安全性和结果方面发挥了关键作用。目前，美国约有40个中心开展LDLT，高容量中心发挥了带头作用。LDLT的培训模式正在不断发展，诸如ASTS LDLT大师班等举措旨在提高手术专业水平。虽然LDLT已融入美国的肝移植实践中，但其扩展受到风险规避和DDLT可用性的阻碍。尽管如此，LDLT对于解决肝移植中的供需不匹配问题至关重要。
