Kapoor Sorabh, Desai Chirag S
Division of Abdominal Transplantation, Department of Surgery, University of North Carolina, Chapel Hill, NC 27599, USA.
J Clin Med. 2025 Mar 26;14(7):2259. doi: 10.3390/jcm14072259.
Living donor transplantation constitutes a small portion of total transplants in the United States as compared Southeast Asia and Middle East. Recent consensus meeting has identified reluctance on the part of transplant providers and donor financial concerns as the major hindrance in increasing the Living donor liver transplants in US. There is a need to carefully analyze the recent outcome data from across the globe and from large volume North American centers that clearly establishes the benefit of Living donor transplants for both adults and children and reducing wait list mortality. LDLT also provides an opportunity for expanding the indications to offer transplant for indications like colorectal metastasis and intrahepatic cholangiocarcinoma without reducing the number of livers available for traditional indications. Recent expansion of perfusion technology has demonstrated significant increase in utilization of Non heart beating donor livers over the last few years. However, with simultaneous increase in patients being added to the wait list, the wait list mortality and dropouts have been persistently high. In this opinion piece, the authors have looked at the transplant trends in the US in the last few years and advocate for adopting a complementary rather than a singular approach for expansion of LDLT along with new perfusion technologies for increasing the number of liver transplants in the US.
与东南亚和中东相比，活体供体移植在美国全部移植手术中所占比例较小。最近的共识会议指出，移植提供者的不情愿以及供体的经济担忧是阻碍美国活体供肝移植数量增加的主要因素。有必要仔细分析全球以及北美大型中心的最新结果数据，这些数据明确证实了活体供体移植对成人和儿童的益处，并降低了等待名单上的死亡率。活体肝移植还为扩大适应症提供了机会，比如为结直肠癌转移和肝内胆管癌等适应症提供移植，同时又不减少可用于传统适应症的肝脏数量。最近灌注技术的发展表明，在过去几年中，非心脏跳动供体肝脏的利用率显著提高。然而，随着等待名单上患者数量的同时增加，等待名单上的死亡率和退出率一直居高不下。在这篇观点文章中，作者审视了美国过去几年的移植趋势，并主张采用一种互补而非单一的方法来扩大活体肝移植，同时结合新的灌注技术，以增加美国肝脏移植的数量。
