Complications of right lobe living donor liver transplantation
Complications of right lobe living donor liver transplantation
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DOI：
10.1016/j.jhep.2009.04.023
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发表时间：
2009-10-01
影响因子：
25.7
通讯作者：
Starzl, Thomas E.
中科院分区：
文献类型：
--
作者：
Marsh, James W.;Gray, Edward;Starzl, Thomas E.
背景/目标：右叶活体肝移植（LDLT）一直存在争议，因为供体死亡和受体和供体发病率的报道差异很大。我们的目的是确保充分披露给捐助者和接受者的风险和利益，这一程序在一个大型大学center.Methods的报告，以帮助解释不一致：Clavien 5层分级系统回顾性应用于121个连续的成人右叶受体和他们的捐助者。确定移植后第一年内潜在（III级）、实际（IV级）或最终致死性（V级）并发症的发生率。当患者有一个以上的并发症，只有精液的一个被计算，或最严重的一个，如果并发症发生contemporaneous.Results：一年受体/移植物存活率为91%/84%。一年内，121名接受者中有80名（66%）出现III级（n = 54）、IV级（n = 16）或V级（n = 10）并发症。并发症涉及移植物的胆道（42%的发生率）、移植物血管（15%）或非移植物位置（9%）。第一年的并发症并没有随着团队经验的增加而减少，并对5年的生存率产生不利影响。121名捐献者全部存活。然而，13个捐助者（10.7%）有III级（n = 9）或IV级（n = 4）的并发症，其中5个是移植物related.Conclusions：尽管令人满意的收件人和移植物的生存在我们和选定的其他机构，虽然我们还没有捐助者死亡的日期，右叶LDLT的作用是不清楚的，因为收件人的发病率和风险的捐助者。(C)2009年欧洲肝脏研究协会。Elsevier B.V.出版，保留所有权利。
Background/Aims: Right lobar living donor liver transplantation (LDLT) has been controversial because of donor deaths and widely variable reports of recipient and donor morbidity. Our aims were to ensure full disclosure to donors and recipients of the risks and benefits of this procedure in a large University center and to help explain reporting inconsistencies.Methods: The Clavien 5-tier grading system was applied retrospectively in 121 consecutive adult right lobe recipients and their donors. The incidence was determined of potentially (Grade III), actually (Grade IV), or ultimately fatal (Grade V) complications during the first post-transplant year. When patients had more than one complication, only the seminal one was counted, or the most serious one if complications occurred contemporaneously.Results: One year recipient/graft survival was 91%/84%. Within the year, 80 (66%) of the 121 recipients had Grade III (n = 54) Grade IV (n = 16), or Grade V (n = 10) complications. The complications involved the graft's biliary tract (42% incidence), graft vasculature (15%), or non-graft locations (9%). Complications during the first year did not decline with increased team experience, and adversely affected survival out to 5 years. All 121 donors survive. However, 13 donors (10.7%) had Grade III (n = 9) or IV (n = 4) complications of which five were graft-related.Conclusions: Despite the satisfactory recipient and graft survival at our and selected other institutions, and although we have not had a donor mortality to date, the role of right lobar LDLT is not clear because of the recipient morbidity and risk to the donors. (C) 2009 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.