Gratt Safety Limits in LRLT : Donor and Recipient

自1990年在日本信州大学和京都大学，活体相关肝移植（LRLT）已被用作治疗晚期肝病患者的一种形式。从这时起，我们的注意力转向了两个反复出现的问题。其中一个问题是，在不损害供体健康状况的情况下，可以移植多少肝组织。另一个是关于更小的移植物可以支持受体的代谢需求。在过去的四年中，我们已经进行了32例LRLT，存活率约为90%（32例患者中有28例），并努力解决了这两个问题。在这里，我们简要地描述一些结论。38例供体中，14例行左外侧节段切除术；13名供体接受了左侧外侧节段切除术，11名供体接受了左侧肺叶切除术。所有的捐赠者术后都没有出现严重的并发症，平均一周就出院了，两个月内就恢复了社交活动。基于这些结果，可以清楚地表明，左肺叶切除术可以在正常受试者中进行移植，而不会出现与实质减少有关的问题。至于更小的移植物，可以满足受体的需求，我们成功地移植到一个成年患者的移植物，只有估计标准肝脏体积的34%（基于体表面积）。它代表了一个肝功能良好的供体，一个基于安全代谢限制（为肝切除术建立的）采集和移植的移植物，并且由于与LRLT相关的良好保存条件也证实了其生存能力。分析这四年获得的数据，我们可以得出结论，对于健康的供体甚至提供整个左叶，以及接受移植的受体，从体表面积计算，至少代表其标准肝脏体积的34%，LRLT是一种安全的手术。这些限制比以前使用的范围更广，允许LRLT的一系列新的安全适应症。少

Since the year of 1990 in Shinshu University and Kyoto University, the living-related liver transplantation (LRLT) has been used as a form of treatment for terminal liver disease patients. From this time, our attention has been turned to two problems that repeatedly appeared.One of the problems is how much liver tissue can be taken as a graft without compromising the donor's health status. The other one is about the smaller graft that can support the recipient's metabolic demands.In the last four years period we have performed 32 LRLT with a survival rate of about 90% (28 out of 32 patients) and have worked to solve these two problems. Here we briefly describe some of the conclusions.From the total of 38 donors, 14 were submitted to left lateral segmentectomy ; 13 donors submitted to extended left lateral segmentectomy, and 11 donors submitted to a left lobectomy. All the donors had a postoperative period without major complications, being discharged in an average of one week, and retu … More rning to their social activities within two months. Based on these results it was made clear that the left lobectomy can be carried out for grafting in a normal subject without problems related to parenchyma reduction.With regard to the smaller graft that can fit the demands of the recipient, we successfully transplanted to an adult patient a graft that was as small as 34% of the estimated standard liver volume (based on the body surface area). It represents a donor with good liver function, a graft harvested and transplanted based on safety metabolic limits (established for hepatectomies) , and also confirms the viability due to excellent preservation conditions related to the LRLT.Analyzing the data obtained in these four years, we could conclude that the LRLT can be a safe procedure for healthy donors providing even the whole left lobe and for recipients receiving a graft that represents at least 34% of their standard liver volume, calculated from the body surface area. These limits, broader that the ones formerly in use, permit a new array of safe indications for LRLT. Less