Assessment of the global practice of living donor liver transplantation
Assessment of the global practice of living donor liver transplantation
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DOI：
10.1111/tri.13960
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发表时间：
2021-09-14
影响因子：
3.1
通讯作者：
Genyk, Yuri
中科院分区：
文献类型：
--
作者：
Emamaullee, Juliet;Conrad, Claire;Genyk, Yuri
驱动活体肝脏供体选择和利用的标准是有限的。在此，活体肝移植（LDLT）的全球可用性以及供体选择和利用的组成部分通过国际调查进行了评估。共有来自41个国家的124名受访者，其中47名来自亚洲/中东（A/ME），20名来自欧洲，57名来自美洲。从94.9%的LDLT病例数>= 10例/年的国家获得了答复。大多数中心（82.3%）有明确的供体年龄标准（中位数18-60岁），而预设的受体MELD截止值（中位数18-30岁）仅在54.8%的项目中报告。总体而言，67.5%的计划预设了供体BMI（体重指数）范围（中位数18-30），A/ME的平均可接受的巨大脂肪变性最高（20.2 +/- 9.2%），美洲最低（16.5 +/-8.4%，P = 0.04）。美洲（56.1%）和欧洲（60.0%）计划更可能考虑匿名捐赠者，而A/ME计划（27.7%，P = 0.01）。在考虑复杂解剖变异方面没有差异。大多数程序（75.9%）通过开放方法进行供体手术，A/ME程序更可能使用显微镜动脉重建。尽管实践中存在差异，但确定了活体捐献者选择的关键方面。这些发现提供了一个当代的参考点，因为LDLT继续扩展到有限的肝移植领域。
Criteria that drive the selection and utilization of living liver donors are limited. Herein, the global availability of living donor liver transplantation (LDLT) and components of donor selection and utilization were assessed via an international survey. There were 124 respondents representing 41 countries, including 47 from Asia/Middle East (A/ME), 20 from Europe, and 57 from the Americas. Responses were obtained from 94.9% of countries with >= 10 LDLT cases/year. Most centers (82.3%) have defined donor age criteria (median 18-60 years), while preset recipient MELD cutoffs (median 18-30) were only reported in 54.8% of programs. Overall, 67.5% of programs have preset donor BMI (body mass index) ranges (median 18-30), and the mean acceptable macrosteatosis was highest for A/ME (20.2 +/- 9.2%) and lowest for Americas (16.5 +/- 8.4%, P = 0.04). Americas (56.1%) and European (60.0%) programs were more likely to consider anonymous donors versus A/ME programs (27.7%, P = 0.01). There were no differences in consideration of complex anatomical variations. Most programs (75.9%) perform donor surgery via an open approach, and A/ME programs are more likely to use microscopic arterial reconstruction. Despite variations in practice, key aspects of living donor selection were identified. These findings provide a contemporary reference point as LDLT continues to expand into areas with limited access to liver transplantation.