Donor morbidity in right and left hemiliver living donor liver transplantation: the impact of graft selection and surgical innovation on donor safety.
Donor morbidity in right and left hemiliver living donor liver transplantation: the impact of graft selection and surgical innovation on donor safety.
复制标题
左右半肝活体肝移植中的供者发病率：移植物选择和手术创新对供者安全的影响。
DOI：
10.1111/tri.12414
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Uemoto S.
中科院分区：
文献类型：
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作者：
Iwasaki J;Iida T;Mizumoto M;Uemura T;Yagi S;Hori T;Ogawa K;Fujimoto Y;Mori A;Kaido T;Uemoto S.
本研究通过比较活体供者的右半肝和左半肝（分别为RL和LL）的术后供者肝功能和发病率，研究了供者安全性的适当肝移植选择。2006年4月至2012年3月，在京都大学医院进行了RL（n= 168）和LL（n= 140）供体肝移植手术。RL供体术后高胆红素血症和凝血功能障碍持续存在，而LL供体的肝功能正常化更快。RL供体的总体并发症发生率显著高于LL供体（59.5% vs. 30.7%;P< 0.001）。两个供体组之间的Clavien IIIa级以上严重并发症或胆道并发症发生率无显著差异。在2006年4月，我们引进了一种创新的外科手术：在供体肝切除术中，肝门剥离保留了胆管的血液供应。与我们以前的结果（1990-2006）相比，RL供体的胆道并发症发生率从12.2%降至7.2%，并且这些并发症的严重程度显著降低。总之，LL供体术后肝功能恢复良好，发病率较低，我们的手术创新降低了活体供体胆道并发症的严重程度。
This study investigated adequate liver graft selection for donor safety by comparing postoperative donor liver function and morbidity between the right and left hemilivers (RL and LL, respectively) of living donors. Between April 2006 and March 2012, RL (n= 168) and LL (n= 140) donor operations were performed for liver transplantation at Kyoto University Hospital. Postoperative hyperbilirubinemia and coagulopathy persisted in RL donors, whereas the liver function of LL donors normalized more rapidly. The overall complication rate of the RL donors was significantly higher than that of the LL donors (59.5% vs. 30.7%;P< 0.001). There were no significant differences in severe complications worse than Clavien grade IIIa or in biliary complication rates between the two donor groups. In April 2006, we introduced an innovative surgical procedure: hilar dissection preserving the blood supply to the bile duct during donor hepatectomy. Compared with our previous outcomes (1990–2006), the biliary complication rate of the RL donors decreased from 12.2% to 7.2%, and the severity of these complications was significantly lower. In conclusion, LL donors demonstrated good recovery in postoperative liver function and lower morbidity, and our surgical innovations reduced the severity of biliary complications in living donors.