One hundred in situ split-liver transplantations - A single-center experience
One hundred in situ split-liver transplantations - A single-center experience
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DOI：
10.1097/01.sla.0000089852.29654.72
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发表时间：
2003-10-01
影响因子：
9
通讯作者：
Busuttil, RW
中科院分区：
文献类型：
--
作者：
Yersiz, H;Renz, JF;Busuttil, RW
背景资料：劈离式肝移植是一种从一个尸体供者身上产生2个同种异体移植物的外科技术。我们已经将劈离式肝移植应用于所有适应症和医疗紧急情况的类别，用于初次和再次移植，以扩大当前的供体库并减少对活体捐赠的依赖。方法：回顾性分析了100例连续的原位劈离式肝移植术，这些肝移植术是在加州洛杉矶大学9/10/10之间进行的。91/03。这100例移植产生了190例同种异体移植物，移植给105名儿童和60名成人，美国各地的移植中心共享25例同种异体移植物。结果和并发症的发生率与同期接受肝移植的活体供者和全器官受者进行了比较，并通过多变量分析确定了劈离式肝移植和受体存活的独立预测因素。在接受左外侧段移植物的受者中观察到的胆道和血管并发症的发生率是通过劈裂-肝移植与接受活体捐赠的左外侧段移植物或接受儿科捐赠者的全器官移植的儿童没有统计学差异。Kaplan-Meier法估计的左外侧段移植物和受体存活率也表明，劈离肝、活体供体和全器官受体之间无统计学差异。劈离式肝移植的右三段移植物显示胆道并发症的发生率为10%，血管并发症的发生率为7%。长期移植物功能良好，患者和移植物存活率等于1086例来自10-40岁供体的尸体全器官移植受者，这些受者在同一时期接受了移植手术。劈离式肝移植移植物和受体存活的预测因素包括器官共享联合网络移植时的状态，指征，并发症的发生，供体肌酐，供体住院时间。结论：劈离式肝移植是一种有效的机制，立即扩大尸体供体库，可以减少对成人和儿童活体捐赠的依赖。
Background Data: Split-liver transplantation is a surgical technique that creates 2 allografts from a single cadaver donor. We have applied split-liver transplantation to all indications and categories of medical urgency for initial as well as retransplantation to expand the current donor pool and decrease reliance upon living donation.Methods: A retrospective analysis was conducted of 100 consecutive in situ split-liver transplantations yielding a left lateral segment and right trisegment graft that were performed at the University of California Los Angeles between 9/91 and 02/03. These 100 transplantations generated 190 allografts for transplantation into 105 children and 60 adults, with the sharing of 25 allografts among transplant centers across the United States. Outcomes and incidence of complications were compared with living donor and whole organ recipients receiving liver transplantation during the same time period with independent predictors of split-liver graft and recipient survival identified by multivariate analysis.Results: The incidence of biliary and vascular complications observed in recipients of left lateral segment grafts created by split-liver transplantation was not statistically different from recipients of left lateral segment grafts created from living donation or children receiving whole-organ grafts from pediatric donors. Kaplan-Meier survival estimations of left lateral segment graft and recipient survival also demonstrated no statistical difference among split-liver, living donor, and whole-organ recipients. Right trisegment grafts from split-liver transplantation demonstrated a 10% incidence of biliary and 7% incidence of vascular complications. Long-term graft function was excellent with patient and graft survival equal to 1086 recipients of cadaver whole-organ grafts from donors ages 10-40 years who underwent transplant operations during the same time period. Predictors of split-liver transplantation graft and recipient survival included United Network for Organ Sharing status at transplantation, indication, occurrence of a complication, donor creatinine, and donor length of hospitalization.Conclusions: Split-liver transplantation is an effective mechanism for immediate expansion of the cadaver donor pool that can reduce dependence upon living donation in adults and children.