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1.
Tsang LL Chen CL Huang TL Chen TY Wang CC Ou HY Lin LH Cheng YF 《Transplantation proceedings》2008,40(8):2460-2462
Accurate pretransplant evaluation of a potential donor in living donor liver transplantation (LDLT) is essential in preventing postoperative liver failure and optimizing safety. The aim of this study was to investigate the reasons for exclusion from donation of potential donors in adult LDLT. From September 2003 to June 2006, 266 potential donors were evaluated for 215 recipients: 220 potential donors for 176 adult recipients; 46 for 39 pediatric recipients. Imaging modalities including Doppler ultrasound, computerized tomography (CT), and magnetic resonance (MR) angiography provided vascular evaluation and MR cholangiopancreatography to evaluate biliary anatomy. Calculation of liver volume and assessment of steatosis were performed by enhanced and nonenhanced CT, respectively. In the adult group, only 83 (37.7%) potential donors were considered suitable for LDLT. Of the 137 unsuitable potential donors, 36 (26.2%) candidates were canceled because of recipient issues that included death of 15 recipients (10.9%), main portal vein thrombosis (8%), recipient condition beyond surgery (5%), and no indication for liver transplantation due to disease improvement (2%). The remaining 101 (73.8%) candidates who were excluded included steatosis (27.7%), an inadequate remnant volume (57.4%), small-for-size graft (8.9%), HLA-homozygous donor leading to one-way donor-recipient HLA match (3%), psychosocial problems (4%), as well as variations of hepatic artery (4%), portal vein (1%), and biliary system anatomy (5%). Anatomic considerations were not the main reason for exclusion of potential donors. An inadequate remnant liver volume (<30%) is the crucial point for the adult LDLT decision. 相似文献
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R. Bustelos C. Garfia A. Moreno B. Perez J.C. Meneu E. Moreno C. Ribera 《Transplantation proceedings》2009,41(9):3791-3795
Bleeding and thrombosis are serious complications of living donor liver transplantation (LDLT). The aim of this paper was to describe the results of a screening for coagulation disorders, including for thrombophilic factors, in potential living liver graft donors and to evaluate thrombotic and bleeding events in donors and recipients, during and after the procedure. From January 2001 to January 2007, 41 LDLTs were performed at our institution. We performed systematic screening for bleeding or prothrombotic states among 188 potential donors, 38 (20.2%) of whom showed at least one abnormality. We rejected potential donors with factor V Leiden, prothrombin mutation G20210A, and deficiencies in anticoagulant proteins (protein C, protein S, and antithrombin) or coagulation factors. Bleeding and thrombotic events in donors and recipients of the 41 LDLTs were evaluated during 7 days to 70 months follow-up. No major bleeding events were detected in the donors. Neither donor nor recipient experienced venous thrombosis or pulmonary embolism. Among all recipients, six suffered hepatic artery thrombosis including five in the first month probably related to surgery. Deep venous thrombosis and pulmonary embolism are well-known complications of hepatic surgery; Prothrombotic abnormalities in the donor can be transmitted to the recipient, leading to increased risk of serious postoperative events. Although the cost-effectiveness is not definitely established, we recommend systematic screening for hemostatic and prothrombotic disorders to prevent more morbidity of a procedure that already has high risks of bleeding and thrombosis. 相似文献
4.
Abougergi MS Rai R Cohen CK Montgomery R Solga SF 《Progress in transplantation (Aliso Viejo, Calif.)》2006,16(1):28-32
Adult-to-adult living donor liver transplantation is an increasingly important option for 17000 patients awaiting liver transplantation in the United States. However, adult-to-adult living donor liver transplantation volumes peaked in 2001 (N = 518), and have gradually fallen in 2002 (N = 362), 2003 (N = 321), and 2004 (N = 323). Recent concerns about donor safety and ethical considerations have made careful analysis of donor availability and selection criteria critically important. We conducted a retrospective review of our active liver transplant recipient registry (N = 251) and compared it to our living donor registry (N = 231), which included all potential living donors before the selection process. Fifteen percent of recipients accounted for the majority (53%) of donor evaluations, whereas 42% of recipients did not have even a single donor evaluation. Recipient diagnosis appears to have a significant impact on donor availability, with donors rarely evaluated for patients with alcoholic cirrhosis. Careful and stringent selection criteria rule out 67% of potential donors. 相似文献
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Noriyo Yamashiki Yasuhiko Sugawara Sumihito Tamura Junichi Kaneko Kayo Nojiri Masao Omata Masatoshi Makuuchi 《Liver transplantation》2006,12(7):1077-1083
The selection of living donor liver transplantation (LDLT) recipients in regions where deceased donor liver transplantation (DDLT) is rarely performed might be different from that in other centers at which LDLT is an alternative option to DDLT. Records of adult (age > or = 18 yr) patients referred to our center were reviewed to analyze the selection process of LDLT candidates. Among the 533 LDLT candidates, 165 (31%) were rejected due to recipient issues. Advanced hepatocellular carcinoma (HCC) was the most common reason for rejection (n = 55). Among the remaining recipients, 120 patients (22%) were rejected due to donor issues. LDLT was eventually performed in 249 (47%) of the evaluated recipients. There are few options for candidates who are unable to find live donors in regions where DDLT is unrealistic. A more effective and precise approach to recipient and donor evaluation should be pursued. 相似文献
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Shin Hwang Sung-Gyu Lee Young-Joo Lee Kyu-Bo Sung Kwang-Min Park Ki-Hun Kim Chul-Soo Ahn Deok-Bog Moon Gyu-Sam Hwang Kyung-Mo Kim Tae-Yong Ha Dong-Sik Kim Jae-Pil Jung Gi-Won Song 《Liver transplantation》2006,12(6):920-927
Serious complications have occurred in a considerable proportion of living donors of liver transplants, but data from a single high-volume center has rarely been available. We analyzed the medical records of donors and recipients of the first 1,000 living donor liver transplants, performed at Asan Medical Center from December 1994 to June 2005, with a focus on donor safety. There were 107 pediatric and 893 adult transplants. The most common diagnoses were biliary atresia in pediatric recipients (63%) and hepatitis B-associated liver cirrhosis (80%) in adult recipients. Right lobe donors were strictly selected based on liver resection rate and steatosis. From 1,162 living donors, 588 right lobes, 6 extended right lobes, 7 right posterior segments, 464 left lobes, and 107 left lateral segments were obtained. Of these, 837 grafts were implanted singly, whereas 325, along with 1 cadaveric split graft, were implanted as dual grafts into 163 recipients. The 5-yr survival rates were 84.8% in pediatric recipients and 83.2% in adult recipients. There was no donor mortality, but 3.2% of donors experienced major complications. Until the end of 2001, the major donor complication rate was 6.7%, with most occurring in right liver donors. Since 2002, liver resection exceeding 65% of whole liver volume were avoided except for young donors with no hepatic steatosis, and the donor complication rate has been reduced to 1.3%. In conclusion, a majority of major living donor complications appear to be avoidable through the strict selection of living donor and graft type, intensive postoperative surveillance, and timely feedback of surgical techniques. Selection of right lobe graft should be very prudently considered if the donor right liver appears to be larger than 65% of the whole liver volume. 相似文献
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Live donor adult liver transplantation using right lobe grafts: donor evaluation and surgical outcome 总被引:10,自引:0,他引:10
Pomfret EA Pomposelli JJ Lewis WD Gordon FD Burns DL Lally A Raptopoulos V Jenkins RL 《Archives of surgery (Chicago, Ill. : 1960)》2001,136(4):425-433
HYPOTHESIS: Live donor adult liver transplantation (LDALT) is a safe and efficacious treatment for patients with end-stage liver disease. DESIGN: Case-control study. SETTING: Hepatobiliary surgery and liver transplantation unit. PATIENTS: From December 10, 1998, through April 10, 2000, a single team performed 15 LDALT procedures with 2 simultaneous living donor kidney transplants. During this period, 66 potential donors were screened and evaluated. INTERVENTIONS: Potential donors were evaluated with 3-dimensional helical computed tomographic scan, including volume renderings for hepatic lobar volume, vascular anatomy, virtual resection planes, and morphologic features. Suitable donors undergo complete medical and psychiatric evaluation and preoperative arteriography. MAIN OUTCOME MEASURES: Donor demographics, evaluation data, operative data, hospital length of stay, and morbidity. RESULTS: A total of 38 men (58%) and 28 women (42%) were evaluated with 15 donors participating in LDALT. Two additional donors provided kidney grafts for simultaneous transplantation at the time of LDALT. Thirty-two donors (48%) were rejected for either donor or recipient reasons, and 10 patients (15%) elected not to participate after initial screening. Three-dimensional volume renderings by helical computed tomographic scan predicted right lobe liver volume within 92% of actual graft volume. Donor morbidity, including all complications, was 67% with no mortality. Residual liver regenerated to approximately 70% of initial volume within 1 week and 80% within 1 month after surgery. CONCLUSIONS: Donor evaluation is an important component of LDALT. Significant donor morbidity is encountered even with careful selection. To minimize donor morbidity, groups considering initiating living donor programs should have expertise in hepatic resection and vena cava preservation using the "piggyback" technique during liver transplantation. 相似文献
9.
Right lobe living donor liver transplantation. 总被引:35,自引:0,他引:35
A Marcos R A Fisher J M Ham M L Shiffman A J Sanyal V A Luketic R K Sterling M P Posner 《Transplantation》1999,68(6):798-803
BACKGROUND: The shortage of livers for transplantation has prompted transplant centers to seek alternatives to conventional cadaveric liver transplantation. Left lateral segmentectomy from living donors has proven to be a safe operation for the donor with excellent results in the pediatric population. Left lobectomy, conceived to supply more tissue, still provides insufficient liver mass for an average size adult patient. Right lobectomy could supply a graft of adequate size. METHODS: Donors were considered only after recipients were listed according to United Network for Organ Sharing (UNOS) criteria. Donor evaluation included liver biopsy, magnetic resonance imaging, and celiac and mesenteric angiography. The donor operation consisted of a right lobectomy uniformly performed throughout the series as described herein. RESULTS: Twenty-five right lobe living donor liver transplants were performed between adults, with no significant complications in donors. Recipient and graft survival was 88%, with three recipient deaths secondary to uncontrolled sepsis in patients at high risk for liver transplant; all three had functioning grafts. CONCLUSIONS: Right lobe living donor liver transplantation poses challenges that require a meticulous surgical technique to minimize morbidity in the recipient. Right lobectomies for living donation can be performed safely with minimal risk to both donor and recipient although providing adequate liver mass for an average size adult patient. 相似文献
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Yamamoto K Takada Y Fujimoto Y Haga H Oike F Kobayashi N Tanaka K 《Transplantation》2007,83(3):257-262
BACKGROUND: In 2003, we encountered the first donor death for living donor liver transplantation in Japan, which was related to nonalcoholic steatohepatitis (NASH). The aim of this study was to retrospectively investigate the prevalence of NASH among a living donor liver transplantation donor population and to analyze the postoperative course for both donors and recipients of NASH grafts to minimize risk for donors. METHODS: The study population comprised 263 donors who donated the right lobe of the liver between February 1998 and April 2003. Their zero-hour biopsy specimens were screened retrospectively. Regarding severe steatosis or NASH, long-term follow-up results for laboratory data from donors were investigated along with changes in graft histologic findings in recipients. RESULTS: NASH was diagnosed histopathologically in three cases (1.1%). Pathologic examination showed that a donor who died in 2003 had the most severe NASH among the three cases. The remaining two NASH donors had uneventful postoperative courses without complications. All grafts showed improvement with respect to the steatosis and histologic findings of NASH. CONCLUSIONS: Donor safety is a top priority in living donor liver transplantation. To exclude patients with NASH from potential donor lists, careful evaluation, including selective preoperative liver biopsy, should be carried out. 相似文献
11.
Wiederkehr JC Schüller S Camargo CA Ekermann M Avila S Schultz C Lemos I 《Transplantation proceedings》2004,36(4):918-919
Several technical improvements have been made to increase donor pool for pediatric liver transplantation, including reduced-size grafts, split-liver, and recently living donors. The objective of the present study is to report our single-center experience with 60 hepatectomies for living donor liver transplantation in pediatric recipients between June 2000 and December 2002. Donor workup consisted of a complete history and physical examination followed by laboratory test and liver function tests. Graft size was estimated using computed tomography scan or abdominal ultrasound. Liver biopsy was performed in all donors. Arteriogram was performed to evaluate hepatic arterial anatomy. All donors survived the procedure. Only seven patients experienced complications (10.2%), most of which were short term. We conclude that liver living donation for pediatric population is a safe procedure. 相似文献
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�ֶ�����¬ʵ������ �������������� �㣬�� ־������������ ������ �� 《中国实用外科杂志》2011,31(2):162-164
??Adult-adult right lobe graft living donor liver transplantation: an analysis of 21 cases LIN Dong-dong, LU Shi-chun, LI Ning, et al. Liver Transplantation Center, Beijing You’an Hospital, Capital Medical University, Beijing 100069, China
Corresponding author??LI Ning, E-mail??liningbjyah@vip.sina.com
Abstract Objective To investigate the key technical skills in adult-adult right lobe graft living donor liver transplantation. Methods The clinical data of 21 adult donors and recipients who underwent right lobe living donor liver transplantation from April 2007 to May 2009 at Beijing You’an Hospital Affiliated to Capital Medical University were analyzed retrospectively. Results There was no death in donors. Twenty-three complications were cured smoothly. Fifteen complications belonged to Grade I and the other 8 complications belonged to Grade II by Clavien classification. There were 4 recipients death in one month after operation and 7 biliary complications occurred during following-up period. All biliary complications were cured by surgical procedures. Four right lobe grafts included middle hepatic vein (group A), 17 right lobe grafts didn’t include middle hepatic vein (group B). There was no significant difference (χ2 =1.000, P=0.617) in 1 year survival rate between group A (75%) and group B (76%). Conclusion Adult-adult right lobe living donor liver transplantation is an important modality for end-stage liver disease patients, especially for patients with liver failure. Rigorous preoperative evaluation, careful operation, proper distribution of middle hepatic vein to maintain graft and remnant liver functional volume, and intensive postoperative care are guarantee for the safety of donors and recipients in living donor liver transplantation. 相似文献
Corresponding author??LI Ning, E-mail??liningbjyah@vip.sina.com
Abstract Objective To investigate the key technical skills in adult-adult right lobe graft living donor liver transplantation. Methods The clinical data of 21 adult donors and recipients who underwent right lobe living donor liver transplantation from April 2007 to May 2009 at Beijing You’an Hospital Affiliated to Capital Medical University were analyzed retrospectively. Results There was no death in donors. Twenty-three complications were cured smoothly. Fifteen complications belonged to Grade I and the other 8 complications belonged to Grade II by Clavien classification. There were 4 recipients death in one month after operation and 7 biliary complications occurred during following-up period. All biliary complications were cured by surgical procedures. Four right lobe grafts included middle hepatic vein (group A), 17 right lobe grafts didn’t include middle hepatic vein (group B). There was no significant difference (χ2 =1.000, P=0.617) in 1 year survival rate between group A (75%) and group B (76%). Conclusion Adult-adult right lobe living donor liver transplantation is an important modality for end-stage liver disease patients, especially for patients with liver failure. Rigorous preoperative evaluation, careful operation, proper distribution of middle hepatic vein to maintain graft and remnant liver functional volume, and intensive postoperative care are guarantee for the safety of donors and recipients in living donor liver transplantation. 相似文献
13.
目的探讨再次肝移植的原因及效果,并比较不同供肝来源与再移植的关系。
方法回顾性分析2000年1月至2018年5月四川大学华西医院1 429例肝移植受者临床资料。首次肝移植供肝来源分别为尸体供肝686例、心脏死亡器官捐献(DCD)供肝346例和活体供肝397例。其中31例受者接受再次肝移植(32例次,其中1例受者接受2次再移植),再移植率为2.24%(32/1 429),供肝来源分别为尸体供肝23例、DCD供肝6例、活体供3例。再移植间隔时间中位数为311 d(88~845 d),间隔1~7 d 3例,8~30 d 1例,31~365 d 15例,>1年13例。采用Kaplan-Meier法计算肝脏再移植术后受者生存时间并绘制生存曲线,采用Breslow法比较再移植间隔时间>1年及≤1年的受者1、5和10年生存率,采用Fisher确切概率法比较不同供肝来源的受者再移植率。P<0.05为差异有统计学意义。
结果截至2018年5月,31例肝脏再移植受者术后12例存活(38.7%)、19例死亡(61.3%),中位生存时间为17个月(2~102个月)。尸体供肝、DCD供肝和活体供肝再移植率分别为3.4%(23/686)、1.7%(6/346)和0.8%(3/367)。尸体供肝再移植率高于活体肝移植,差异有统计学意义(P=0.007),DCD供肝再移植率与尸体供肝、活体供肝再移植率相比,差别均无统计学意义(P=0.137和0.222)。其中18例再移植间隔时间<1年的受者,6例存活、12例死亡;13例再移植间隔时间≥1年的受者,6例存活、7例死亡。31例肝脏再移植受者术后1、5和10年生存率分别为64.2%、51.2%和46.6%。再移植间隔时间<1年的受者1、3和5年生存率分别为49.4%、41.2%和30.9%,间隔时间≥1年的受者1、3和5年生存率分别为84.6%、65.8%和65.8%,二者差异无统计学意义(χ2=2.946,P>0.05)。
结论再移植是肝移植术后移植物失功的唯一有效治疗方法,再移植术后受者往往病情危重,围手术期死亡率高,胆道并发症及排斥反应是再次肝移植的主要原因。应该慎重把握再移植手术时机,目前亟待更多的研究对再移植做进一步探讨。 相似文献
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Herrero JI Pardo F Rotellar F Martí P Zozaya G Alegre F D'Avola D Quiroga J 《Transplantation proceedings》2011,43(3):690-691
Introduction
The aim of this study was to investigate the applicability of living donor liver transplantation in a program of adult liver transplantation.Patients and methods
We studied the outcomes of the evaluation of 71 potential donor candidates for 53 adult candidates to liver transplantation.Results
Ten of the potential donor candidates did not complete their evaluation. Among the remaining 61 potential donors, 29 (47.5%) were considered to be suitable donors. Only 17 (24% of the 71 initial candidates) underwent donation. The main causes for unsuitability for liver donation were a small remnant liver and vascular anatomic variants.Conclusion
Fewer than 25% of potential liver donors became effective donors leading us to conclude that adult living donor liver transplantation has a low applicability. 相似文献16.
Silvio Nadalin Massimo Malagó Camino Valentin-Gamazo Giuliano Testa Hideo A Baba Chao Liu Nils R Frühauf Randolph Schaffer Guido Gerken Andrea Frilling Christoph E Broelsch 《Liver transplantation》2005,11(8):980-986
The role of liver biopsy (LB) in donor selection for adult living donor liver transplantation remains controversial, since the procedure is associated with additional potential risks for the donor. From April 1998 to August 2004, 730 potential living donors for 337 adult recipients underwent our multistep evaluation program. In 144 candidates, LB was performed. LB was obtained in a percutaneous ultrasound-guided fashion by means of Menghini needle (32 cases) or Tru-cut needle (112 cases). The biopsy specimen was preserved in 5% formalin and processed with hematoxylin & eosin-stained sections. Thirty-one (21%) of 144 candidates who underwent an LB had a positive finding at histological examination that induced their exclusion from donation, of whom 21 had liver steatosis of varying kind and grade (10%-80%) and 10 had a nonsteatotic hepatopathy (non-A-D hepatitis in 6 cases, diffuse granulomatosis in 2, schistosomiasis in 1, fibrosis in 1). The only observed major complications related to LB were 2 intraparenchymal haematomas, both of which resolved spontaneously within a few months. In conclusion, based on these findings, we believe that preoperative LB in the donor selection for adult LDLT is necessary, once the initial donor screening and noninvasive evaluation is complete. Because other screening modalities can be unreliable, without preoperative LB a fraction of potential donors will be operated on inappropriately, risking both donor and recipient. The main objective of LB should be to ensure the donor's safety more than the preservation of the graft function. 相似文献
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Binet I; Bock A; Vogelbach P; Gasser T; Kiss A; Brunner F; Thiel G 《Nephrology, dialysis, transplantation》1997,12(9):1940-1948
Background. The growing shortage of cadaver kidneys,
the limited possibilities to expand the living related donor pool and the
good results obtained in our centre with poorly matched cadaver kidneys,
led us in 1991 to begin accepting highly motivated, unrelated, living
kidney donors who had a strong emotional bond with the recipients.
Methods. Between 1 January 1991 and 1 January 1996, 46
potential living kidney donors and their emotionally related recipients
were evaluated. Twenty-three cases were accepted for renal transplantation
after thorough somatic and psychological evaluation. The mean
post-transplant follow-up until 1 April 1996 was of 28±3 months.
Compatible blood groups and a negative cross-match were mandatory, but no
minimal HLA matching was required. Results. There was
a 50% drop-out rate following the initial screening. The main reasons for
not performing transplantation were immunological contraindications in 39%
of the cases, somatic in 30.5%, psychological in 26% and socioeconomic in
4.5%. In the accepted group of recipients, 48% (11/23) received transplants
without chronic dialysis. Donor survival was 91%; two deaths unrelated to
nephrectomy occurred 1 year after donation. The 2-year actuarial recipient
and graft survivals were 100% and 91% respectively, compared to 99%
(recipients) and 93% (grafts) in the non-HLA-identical living related
kidney transplant group, and to 93% (recipients) and 83% (grafts) in the
cadaver kidney transplant group. Recipient rehabilitation was completed
after 4±1 months. Emotionally related donors returned to work
5±2 weeks after nephrectomy, and no donor regretted his
decision, even in the case of failure. Conclusions.
Kidney transplantation from emotionally related living donors represents a
valuable option, allowing more patients with end-stage renal disease to
avoid chronic dialysis. Recipient and graft outcome were superior to
cadaver kidney transplantation. Motivated and emotionally related donors
should be allowed to donate one of their kidneys provided that they are
carefully selected and thoroughly informed. 相似文献
19.
Sang Bin Han Gaab Soo Kim Soo Joo Choi Justin Sangwook Ko Mi Sook Gwak Jae Won Joh 《Transplant international》2013,26(6):623-630
Unconjugated bilirubin has shown both cytotoxic and cytoprotective effects, acting as either an oxidant or an antioxidant. Elevated unconjugated bilirubin with otherwise normal, so‐called isolated unconjugated hyperbilirubinemia (IUHB), is encountered frequently in living liver donor evaluation. However, the significance of IUHB on transplantation‐related outcomes has not been clarified in donors and recipients. Forty‐six living donors with IUHB were matched 1:1 with the control donors and 43 recipients who received grafts from donors with IUHB were matched 1:1 with the control recipients. Matched variables included donor/recipient age, residual liver volume, steatosis, cold ischemic time, graft versus recipient weight ratio, the MELD score and others. Donors in the control and IUHB group were comparable regarding the maximum postoperative transaminase concentrations, postoperative complications, and hospital stay. Recipients in the control and IUHB group were comparable regarding primary graft dysfunction, major postoperative complications, long‐term ICU/hospital stay, 1‐year mortality, and rejection rate, as well as recipient/graft survival rates. Recipients' unconjugated bilirubin concentration at 3 years after transplantation was higher in IUHB group with otherwise comparable liver function. It was concluded that living donor liver transplantation is safe for donors with IUHB and their recipients. 相似文献
20.
Liver transplantation using donors with Gilbert syndrome 总被引:2,自引:0,他引:2
Kaneko J Sugawara Y Maruo Y Sato H Tamura S Imamura H Kokudo N Makuuchi M 《Transplantation》2006,82(2):282-285
Serum bilirubin level is an essential factor included in the first step in evaluating living liver donor candidates. Our evaluation strategy was examined in living donors with possible Gilbert's syndrome (GS). When donor candidates had hyperbilirubinemia (>1.5 mg/dl), but otherwise normal liver function tests, their genomic DNA was isolated from leukocytes. They were diagnosed with GS when they had mutations of uridine diphosphate glucuronosyltransferase 1 typical to GS. The donors and recipients were divided into two groups: GS donors and their recipients (n = 6, each) and non-GS donors and their recipients (n = 65). All GS donors and their recipients had an unremarkable postoperative course. Total bilirubin levels of the recipients of GS donors were higher than those of recipients of non-GS donors. Living donor liver transplantation is safe for both donors with GS and their recipients. 相似文献