A Worldwide Survey of Live Liver Donor Selection Policies at 24 Centers With a Combined Experience of 19 009 Adult Living Donor Liver Transplants
A Worldwide Survey of Live Liver Donor Selection Policies at 24 Centers With a Combined Experience of 19 009 Adult Living Donor Liver Transplants
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DOI：
10.1097/tp.0000000000002475
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发表时间：
2019-02-01
期刊：
影响因子：
6.2
通讯作者：
Pomfret, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Soin, Arvinder Singh;Chaudhary, Rohan Jagat;Pomfret, Elizabeth A.
背景尽管活体肝移植（LDLT）的手术技术已经发展到关注供体安全性和受体挑战，但供体选择标准仍然存在很大差异。方法.向全球41个中心发送了关于供体选择的调查问卷。24家临床试验机构（共有19009例LDLT）做出了回复。结果中心被分为主要是LDLT（18）或死亡供体肝移植（6），和高（10）或低容量（14）中心。在大多数中心，最低可接受移植物与受体重量比为0.7或更低（67%），残留物为30%（75%）。供体年龄的中位数上限为60岁，体重指数为33 kg/m2。在63%的中心，年龄对体重指数的上限有相反的影响。大多数患者首选天冬氨酸转氨酶和丙氨酸转氨酶低于50 IU/mL。大多数接受非衰弱性轻度精神或身体残疾的供体，并拒绝接受经治疗的冠状动脉疾病，脑血管意外和非脑，非皮肤原发性恶性肿瘤的供体。关于以前的精神病、药物滥用和腹部手术，意见不一。大多数进行了选择性肝活检，通常用于脂肪变性，转氨酶升高和1个或多个代谢综合征特征。活检时，所有患者均认为大泡性脂肪变性重要，50%认为小泡性脂肪变性重要。几乎所有（92%）的患者因早期纤维化而拒绝供体，少数患者因非特异性肉芽肿或轻度炎症而拒绝供体。除门静脉D/E型外，大多数解剖异常在高容量中心是可接受的。术前或围手术期胆管造影没有标准政策。结论.这项首次大型活体肝脏供体调查提供了对供体选择实践的深入了解，这可能有助于中心之间的标准化，在不影响安全性的情况下扩大供体库。
Background. Although surgical technique in living donor liver transplantation (LDLT) has evolved with a focus on donor safety and recipient challenges, the donor selection criteria remain considerably disparate. Methods. A questionnaire on donor selection was sent to 41 centers worldwide. 24 centers with a combined experience of 19 009 LDLTs responded. Results. Centers were categorized into predominantly LDLT (18) or deceased donor liver transplantation (6), and high-(10) or low-volume (14) centers. Atmost centers, the minimum acceptable graft-to-recipient weight ratio was 0.7 or less (67%), and remnant was 30%(75%). The median upper limit of donor age was 60 years and body mass index of 33 kg/m(2). At 63% centers, age influenced the upper limit of body mass index inversely. Majority preferred aspartate transaminase and alanine transaminase less than 50 IU/mL. Most accepted donors with nondebilitating mild mental or physical disability and rejected donors with treated coronary artery disease, cerebrovascular accident and nonbrain, nonskin primary malignancies. Opinions were divided about previous psychiatric illness, substance abuse and abdominal surgery. Most performed selective liver biopsy, commonly for steatosis, raised transaminases and 1 or more features of metabolic syndrome. On biopsy, all considered macrovesicular and 50% considered microvesicular steatosis important. Nearly all (92%) rejected donors for early fibrosis, and minority for nonspecific granuloma or mild inflammation. Most anatomical anomalies except portal vein type D/E were acceptable at high-volume centers. There was no standard policy for preoperative or peroperative cholangiogram. Conclusions. This first large live liver donor survey provides insight into donor selection practices that may aid standardization between centers, with potential expansion of the donor pool without compromising safety.