原位劈离式肝移植单中心经验

［摘要］　目的　探讨公民逝世后器官捐献原位劈离式肝移植（ISSLT）的临床疗效及其安全性。方法　回顾性分析该院2019-12～2020-11实施的7例ISSLT供者、受者资料。7例供者均为中国Ⅰ类器官捐献,中位年龄33岁,主要诊断为脑出血5例,脑外伤2例。ICU住院时间为(3.4±2.5)d。经严格评估后其中5例行在体肝劈离并获得10例具有独立解剖功能的肝段。2例因门静脉解剖变异而放弃劈离,行劈离的5例ISSLT中,均为成人-儿童组合。该移植中心受者肝移植手术病例右侧肝叶采用经典肝移植手术,左侧肝叶采用背驼式肝移植手术方式。结果　10例受者中,手术时间为（394±58）min,出血量为1 600（100～3 000）ml。截至2020-11,受者中位随访时间为6个月,均未出现出血以及血管、胆道、腹腔感染等严重并发症。结论　ISSLT可以在经过严格评估后的脑死亡供体中安全开展,术后疗效良好,提高了供肝的使用率。     

活体及劈离式肝移植术后减体积移植肝再生影响因素研究进展

目前,肝移植已成为治疗终末期肝病的最有效手段,等待移植的患者迅速增加,这使得供肝匮乏的问题日益突出。针对供肝短缺,可通过开展活体肝移植和劈离式肝移植等技术增加供体量。在活体肝移植和劈离式肝移植中,由于受供肝大小的限制,易出现移植肝体积偏小、有效肝容量不足等问题。因此,如何促使减体积移植肝迅速增生以满足受体合     

肝移植

<正>1963年,Starzl施行了第一例人类肝移植。Calne于1967年开始进行肝移植的研究,并于1979年首先将环孢素应用于人类肝移植的免疫抑制治疗,彻底改变了肝移植徘徊不前的局面,成为肝移植史上一个重要的里程碑。1980年,Starzl首先联合应用环孢素和皮质激素抑制免疫排异反应。在1年时间内,病人6个月生存     

肝移植研究进展——肝移植术后排斥反应和免疫抑制治疗

器官移植术后排斥反应是由于受者免疫系统识别供体异体抗原引起的一系列免疫反应 ,最终可导致移植物破坏和功能丧失。肝脏是公认的移植特惠器官 ,同种异体肝脏移植术后的排斥反应没有肾、心脏等脏器移植严重 ,推测与肝细胞所携带的表面抗原较少有关。然而 ,排斥反应依然是肝移植术后的主要并发症之一 ,占肝移植死亡原因的 10 %～ 2 0 %。1　肝移植术后排斥反应类型　　临床上 ,根据排斥反应发生时间和组织学改变将肝移植术后排斥反应分为超急性排斥反应、急性排斥反应、慢性排斥反应。1.1　超急性排斥反应　在肝移植中非常罕见 ,其是由抗体…     

肝移植研究进展——肝移植术后乙肝复发的预防和治疗

乙型肝炎病毒 (HBV)所致的临床感染如急性肝炎、慢性肝炎、重型型炎、无症状 HBs Ag携带等 ,最终导致终末期肝病。由于目前对 HBV尚缺乏有效的治疗手段 ,故这些患者最终需要接受肝移植治疗。但存在术后移植肝的乙肝复发率高和再感染问题。目前 ,将肝移植后乙肝病毒 (HBV )再感染定义为 :血或肝组织中出现 HBs Ag、HBe Ag或 HBV- DNA中之一。肝移植后肝炎复发定义为 :血或肝组织中 HBV标记物阳性 ,肝功能异常 ,伴有病毒性肝炎症状与体征及肝组织病理学改变。乙肝复发后病变发展迅速 ,可在 1～ 2年内导致移植肝的纤维化 ,直至肝功…     

肝移植术并发症的病理变化

目前,原位肝移植在国内已得到较广泛开展,在手术技术日臻完善的基础上,防治术后并发症,提高患者生存时问及健康质量已成为肝移植的重点课题.     

供肝处理对肝移植术后早期胆道并发症的影响

胆道并发症是原位肝移植术后常见的并发症，也是目前导致肝移植失败的主要原因之一。目前，术后胆道并发症的发生率仍高达10％-30％，而且常需要二次手术处理。供肝的质量是术后胆道并发症发生与否的关键。本研究回顾性分析临床资料，观察改进供体处理方法后肝移植术后早期胆道并发症的发生情况。[第一段]     

Current status and perspectives in split liver transplantation

Growing experience with the liver splitting technique and favorable results equivalent to those of whole liver transplant have led to wider application of split liver transplantation(SLT) for adult and pediatric recipients in the last decade. Conversely, SLT for two adult recipients remains a challenging surgical procedure and outcomes have yet to improve. Differences in organ shortages together with religious and ethical issues related to cadaveric organ donation have had an impact on the worldwide distribution of SLT. Despite technical refinements and a better understanding of the complex liver anatomy, SLT remains a technically and logistically demanding surgical procedure. This article reviews the surgical and clinical advances in this field of liver transplantation focusing on the role of SLT and the issues that may lead a further expansion of this complex surgical procedure.     

Using on-site liver 3-D reconstruction and volumetric calculations in split liver transplantation

BACKGROUND: Split liver transplantation increases the number of grafts available for transplantation. Pre-recovery assessment of liver graft volume is essential for selecting suit-able recipients. The purpose of this study was to determine the ability and feasibility of constructing a 3-D model to aid in surgical planning and to predict graft weight prior to anin situ division of the donor liver.
METHODS: Over 11 months, 3-D volumetric reconstruction of 4 deceased donors was performed using Pathifnder Scout? liver volumetric software. Demographic, laboratory, operative, perioperative and survival data for these patients along with donor demographic data were collected prospectively and analyzed retrospectively.
RESULTS: The average predicted weight of the grafts from the adult donors obtained from anin situ split procedure were 1130 g (930-1458 g) for the extended right lobe donors and 312 g (222-396 g) for left lateral segment grafts. Actual adult graft weight was 92% of the predicted weight for both the ex-tended right grafts and the left lateral segment grafts. The pre-dicted and actual graft weights for the pediatric donors were 176 g and 210 g for the left lateral segment grafts and 308 g and 280 g for the extended right lobe grafts, respectively. All grafts were transplanted except for the right lobe from the pediatric donors due to the small graft weight.
CONCLUSIONS: On-site volumetric assessment of donors provides useful information for the planning of anin situ split and for selection of recipients. This information may expand the donor pool to recipients previously felt to be unsuitable due to donor and/or recipient weight.     

Outcomes of split versus reduced-size grafts in pediatric liver transplantation

BACKGROUND: Split-liver transplantation, where two grafts are created from a single donor organ, is a means of overcoming donor organ scarcity. There are few data comparing outcomes of split with reduced-size liver grafts, which is the most common type of cadaveric graft in pediatric liver transplantation. The aims of the present paper were to compare survival and complication rates between split and reduced-size cadaveric grafts in pediatric patients receiving a liver transplant in Brisbane. METHODS: Review of the Queensland Liver Transplant Service database was undertaken. All pediatric patients who received either a cadaveric split or reduced-size graft between 1985 and 2000 were examined. The incidence of patient and graft survival, vascular complications and biliary complications were identified. RESULTS: A total of 251 liver transplants were performed of which 138 were reduced-size grafts and 30 were split grafts. There were no differences in etiology of liver disease, mean age, weight, and urgency of transplant between the two groups. One-year patient and graft survivals were comparable at 73% and 67%, respectively, in both groups. There was no difference in the incidence of vascular complications between groups. Biliary complications were significantly more common after split grafts when compared with reduced-size grafts (21%vs 4%, P < 0.0001) but did not affect patient or graft survival. CONCLUSIONS: Survival and vascular complications after split-liver grafts were comparable to outcomes after reduced-size grafts. Biliary complications occur more commonly with split-liver grafts but did not affect patient or graft survival. It is recommended that every pediatric recipient be considered for a split-liver graft.     

Surgical advances in liver transplantation. Living related and split donors

Surgical innovations to expand an exceedingly small cadaveric liver pool have paved the way for the more complex procedure of adult-to-adult living donation. Although reduced-size liver transplant (RSLT) has provided children and small adults with much needed small size grafts, discarding a part of the liver can no longer be justified in the current era of severe organ shortage. Split liver transplantation may eliminate the need for RSLT and may replace adult-to-adult pediatric donation except in urgent situations. Adult-to-adult living donation is a formidable undertaking that tremendously impacts adult recipients. Adult-to-adult living donation should be approached cautiously to ensure the safety of living donors. Expansion of adult living donation can only be achieved when ethical issues of donation are resolved and long-term donor safety is established.