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活体肝移植

Author
Scott J Cotler, MD
Section Editor
Robert S Brown, Jr, MD, MPH
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
尹新民, 主任医师，教授

引言

供者器官短缺是肝移植的限制因素。虽然美国每年都要施行6000多例肝移植，但每年也有2000多名肝移植等待名单上的候选者死亡。活体供肝肝移植(living donor liver transplantation, LDLT)扩大了器官来源。肝左外叶活体肝移植已在儿科肝移植中取得了极大成功。有些移植中心进行了成人与成人间的肝右叶LDLT，以及较少使用的肝左叶LDLT。

LDLT的优点包括完善的供者筛选、最佳的移植时机和最短的冷缺血时间[1]。相对于等待尸肝来说，LDLT的受者死亡率也较低[2]。一项决策分析认为：为标准尸体供肝肝移植等待名单上的患者引入LDLT可有效提高受者存活率并防止受者在等候过程中死亡，但成本更高[3]。而之后的一项队列研究发现，由经验丰富的移植中心实施LDLT时，其成本和尸肝移植相差不大[4]。

然而，LDLT给供者带来了风险。美国的LDLT手术量在2001年达到最高峰，为519例，之后从2003年起下降到每年约320例，因为对并发症的担忧降低了人们对LDLT的热情[5]。

本专题将总结活体供肝肝移植。肝移植的其他问题将在别处讨论，如患者选择、移植术后医护、尸体供者器官选择和并发症。 (参见“成人肝移植：患者选择和术前评估”和“成人肝移植受者的长期管理”和“成人肝脏移植的免疫抑制概述”和“肝脏移植的供者选择”和“肝移植的感染性并发症”)

伦理

关于LDLT的伦理问题主要与供者出现并发症和死亡的可能有关。反对者认为，使健康供者遭受长期衰弱甚或死亡的风险让人无法接受。在主要用于儿科肝移植的肝左外叶或者肝左叶捐献中，供者的手术并发症发生率为5%-10%，死亡率低于1%[6,7]。而在成人间LDLT所采用的肝右叶捐献中，死亡率估计为0.5%左右。 (参见下文‘供者结局’)

           

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-23.
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