Tanaka K, Uemoto S, Tokunaga Y, Fujita S, Sano K, Nishizawa T, Sawada H, Shirahase I, Kim H J, Yamaoka Y
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Ann Surg. 1993 Jan;217(1):82-91. doi: 10.1097/00000658-199301000-00014.
The authors successfully performed a series of 33 living related liver transplantations (LRLT) on children (15 males and 18 females, ranging from 7 months to 15 years of age) from June 1990 to May 1992, with the informed consent of their parents and the approval of the Ethics Committee of Kyoto University. Before operation, six of the children required intensive care, another 14 were hospitalized, and 13 were homebound. Donors (12 paternal and 21 maternal) were selected solely from the parents of the recipients on the basis of ABO blood group and graft/recipient size matching determined by computed tomography scanning. Procurement of graft was performed using ultrasonic aspirator and bipolar electrocautery without blood vessel clamping and without graft manipulation. All donors subsequently had normal liver function and returned to normal life. The left lateral segment (16 cases), left lobe (16 cases), or right lobe (one case) were used as grafts. The partial liver graft was transplanted into the recipient who underwent total hepatectomy with preservation of the inferior vena cava using a vascular side clamp. Twenty-seven of 33 recipients are alive and well with the original graft and have normal liver function. The patient survival rate was 89% (24/27) in elective cases and 50% (3/6) in emergent cases. The other six recipients had functioning grafts but died of extrahepatic complications. Complications of the graft were minimal in all cases. Hepatic vein stenosis, which occurred three times in two cases, was successfully treated by balloon dilatation. In cases with sclerotic portal vein, the authors anastomosed the portal vein of the graft to the confluence of the splenic vein and the superior mesenteric vein without a vascular graft, after experiencing a case of vascular graft thrombosis. After hepatic artery thrombosis occurred in one of the initial seven recipients whose arterial anastomosis was done with surgical loupe, microsurgery was introduced for hepatic artery reconstruction. There has been no occurrence of thrombosis since then. The current results with LRLT suggested that the meticulous management of surgical factors at each stage of the LRLT procedure is crucial for successful outcome. Living related liver transplantation is a promising option for resolving the graft shortage in pediatric liver transplantation and may be regarded as an independent modality to supplement cadaver donation.
1990年6月至1992年5月期间，作者在获得患儿父母知情同意并经京都大学伦理委员会批准后，成功地为儿童（15名男性和18名女性，年龄从7个月至15岁）进行了一系列33例活体亲属肝移植（LRLT）手术。术前，6名儿童需要重症监护，另外14名住院，13名居家。供体（12名父亲和21名母亲）仅从受体的父母中挑选，依据ABO血型以及通过计算机断层扫描确定的移植物/受体大小匹配情况。采用超声吸引器和双极电凝进行移植物获取，不夹闭血管且不触碰移植物。所有供体随后肝功能均正常并恢复正常生活。使用左外侧叶（16例）、左叶（16例）或右叶（1例）作为移植物。将部分肝移植物移植到接受保留肝下腔静脉的全肝切除术的受体体内，使用血管侧钳。33名受体中有27名存活且移植物功能良好，肝功能正常。择期病例的患者生存率为89%（24/27），急诊病例为50%（3/6）。其他6名受体移植物有功能，但死于肝外并发症。所有病例中移植物的并发症均极少。肝静脉狭窄在2例中发生了3次，通过球囊扩张成功治疗。在出现1例血管移植物血栓形成的病例后，对于门静脉硬化的病例，作者在不使用血管移植物的情况下，将移植物的门静脉与脾静脉和肠系膜上静脉的汇合处进行吻合。在最初7名采用手术放大镜进行动脉吻合的受体中，有1例发生肝动脉血栓形成后，引入显微外科技术进行肝动脉重建。此后未再发生血栓形成。当前LRLT的结果表明，在LRLT手术的每个阶段对手术因素进行细致管理对于取得成功结果至关重要。活体亲属肝移植是解决儿童肝移植中移植物短缺问题的一个有前景的选择，可被视为补充尸体供肝的一种独立方式。
