Kawasaki S, Makuuchi M, Matsunami H, Hashikura Y, Ikegami T, Nakazawa Y, Chisuwa H, Terada M, Miyagawa S
First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Ann Surg. 1998 Feb;227(2):269-74. doi: 10.1097/00000658-199802000-00017.
To evaluate the outcome of living related liver transplantation (LRLT) in adult patients and to assess graft size disparity and graft regeneration.
Although LRLT has been accepted as an optional life-saving procedure for pediatric patients with end-stage liver disease, the feasibility of LRLT for adult patients has not been reported with reference to a clinical series.
Adult-to-adult LRLT was performed using whole left lobar grafts in 13 patients (5 with primary biliary cirrhosis, 6 with familial amyloid polyneuropathy, 1 with biliary atresia, and 1 with citrullinemia). The 13 donors comprised 5 husbands, 3 sons, 2 sisters, 2 fathers, and 1 mother. The ratio of the graft volume to standard liver volume (GV/SV ratio) was calculated for use as a parameter of graft size disparity.
Although the liver graft was markedly small for size (GV/SV ratio 32%-59% at the time of LRLT), none of the 13 patients developed postoperative liver failure. Eleven of the patients are still alive and well with satisfactory graft function 2 to 35 months after LRLT. Graft liver volume increased rapidly after LRLT and approximated the standard liver volume with time.
Our LRLT program for adult patients has produced good results. LRLT in adults can be indicated for selected donor-recipient combinations.
评估成人活体肝移植（LRLT）的疗效，并评估移植物大小差异和移植物再生情况。
尽管LRLT已被公认为是终末期肝病小儿患者的一种可选的挽救生命的手术，但关于成人患者LRLT的可行性尚未有临床系列报道。
对13例患者（5例原发性胆汁性肝硬化、6例家族性淀粉样多神经病、1例胆道闭锁和1例瓜氨酸血症）进行了成人对成人的LRLT，采用全左叶移植物。13名供体包括5名丈夫、3名儿子、2名姐妹、2名父亲和1名母亲。计算移植物体积与标准肝脏体积之比（GV/SV比），用作移植物大小差异的参数。
尽管肝移植物在大小上明显较小（LRLT时GV/SV比为32%-59%），但13例患者均未发生术后肝衰竭。11例患者在LRLT后2至35个月仍存活且情况良好，移植物功能令人满意。LRLT后移植物肝脏体积迅速增加，随时间推移接近标准肝脏体积。
我们针对成人患者的LRLT方案取得了良好效果。成人LRLT可用于选定的供体-受体组合。
