Adult-to-adult live donor liver transplantation: a short-term clinicopathologic study.
Adult-to-adult live donor liver transplantation: a short-term clinicopathologic study.
复制标题
成人对成人活体肝移植：一项短期临床病理学研究。
DOI：
10.1053/hupa.2001.26467
复制
发表时间：
2001
期刊：
影响因子：
3.3
通讯作者：
U. Khettry
中科院分区：
文献类型：
--
作者：
G. Ayata;E. Pomfret;J. Pomposelli;F. Gordon;W. Lewis;R. Jenkins;U. Khettry
随着儿童活体肝移植（LDLT）的成功和尸体供体的持续短缺，成人间LDLT已在一些中心进行，包括我们。我们对9例成年受者在LDLT时和LDLT后获得的所有肝脏标本进行了详细的组织学检查，并将这些发现与患者的病程和结局相关联。5例患者有胆道病理学证据; 3/5例需要手术或放射干预。其他2例患者的胆道疾病临床上不显著。一例术前门静脉高压症患者在门静脉血运重建术后继发于大量门静脉血流的弥漫性肝细胞出血性坏死导致移植失败和再次移植。2例围手术期死亡由败血症和多器官衰竭（第25天）和与凝血因子V相关的全身血栓形成（第6天）引起。术前诊断、自体肝门静脉血栓形成、术后胆管病变和供体肝楔形活检包膜下出血性坏死不影响短期结果。总之，成人间LDLT后胆道病理学常见，但不会对移植物或患者生存产生负面影响。与门静脉血流动力学或血栓形成相关的罕见但灾难性的血管并发症可导致移植物丢失和/或患者死亡。
With the success of pediatric live donor liver transplantation (LDLT) and the continued shortage of cadaveric donors, adult-to-adult LDLT has been performed at some centers, including ours. We performed a detailed histologic review of all liver specimens obtained from 9 adult recipients at and after LDLT and correlated these findings with the patients' course and outcome. Five patients had histologic evidence of biliary tract pathology; 3 of 5 required surgical or radiologic intervention. The other 2 had clinically insignificant biliary disease. Diffuse hepatocytic hemorrhagic necrosis secondary to massive portal blood flow after portal venous revascularization resulted in graft failure and retransplantation in a single patient with severe preoperative portal hypertension. Two perioperative deaths were caused by sepsis and multiorgan failure (day 25) and generalized thrombosis related to factor V Leiden (day 6). The preoperative diagnosis, presence of portal vein thrombosis in the native liver, postoperative cholangiopathy, and subcapsular hemorrhagic necrosis in donor liver wedge biopsies did not affect the short-term outcome. In conclusion, biliary tract pathology is common after adult-to-adult LDLT but does not negatively affect graft or patient survival. Infrequent but catastrophic vascular complications related to portal hemodynamics or thrombosis can result in graft loss and/or patient death.