Orthotopic liver transplantation as a successful treatment of end-stage liver disease is hampered by a persistent lack of cadaveric organs. Split liver transplantation, which was first successfully performed by Medica...Orthotopic liver transplantation as a successful treatment of end-stage liver disease is hampered by a persistent lack of cadaveric organs. Split liver transplantation, which was first successfully performed by Medical School of Hannover in 1988, has become a mature surgical technique to expand the donor pool. Between 1993 and 1999, split liver transplantation activities have increased in Europe from 1. 2% to 10. 4% in all performed liver transplantations. Current data have strongly supported that the survival rate of patients after split liver transplantation is not significantly different from that of patients after whole-size orthotopic liver transplantation. The most important step of donor graft selection is surgeon' s observation judged by the experience of individual transplant center. The paper aims to provide the guideline of donor selection, hepatic graft splitting, and recipient management as well. DATA SOURCES: Medical School of Hannover has accumulated plentiful experience of split liver transplantation for more than 10 cases ever since 1998. Besides that, we also reviewed a variety of literatures from other famous European and American centers specialized in this field for many years. RESULTS:According to our experience combined with the view points of others, the donor should meet the following criteria as well: (1) age less than 50 years; (2) hemodynamics stable; (3) ICU less than 5 days; (4) Na less than 170 mmol/L or better if less than 150 mmol/L. In 1996 and 1997, the Hamburg group and the UCLA group separately introduced a breakthrough technique performing split liver transplantation in situ. Evidently, the in situ technique has been limited by prolonged time of donor organ procurement , coordination with other organ procurement teams, and even extra burden on donor hospital. Some groups, therefore, have restored the ex situ or bench splitting technique , and fortunately the transplant outcomes of the ex situ technique are equivalent to those of the in situ one. Recently some new techniques h展开更多
The shortage of donor livers has led to an increased use of organs from expanded criteria donors. Included are livers with steatosis, a metabolic abnormality that increases the likelihood of graft complications posttr...The shortage of donor livers has led to an increased use of organs from expanded criteria donors. Included are livers with steatosis, a metabolic abnormality that increases the likelihood of graft complications posttransplantation. After a brief introduction on the etiology, pathophysiology, categories and experimental models of hepatic steatosis, we herein review the methods to rescue steatotic donor livers before transplantation applied in clinical and experimental studies. The methods span the spectrum of encouraging donor weight loss, employing drug therapy, heat shock preconditioning, ischemia preconditioning and selective anesthesia on donors, and the treatment on isolated grafts during preservation. These methods work at different stages of transplantation process, although share similar molecular mechanisms including lipid metabolism stimulation through enzymes or nuclear receptor e.g. , peroxisomal proliferator-activated receptor, or anti-inflammation through suppressing cytokines e.g. , tumor necrosis factor-α, or antioxidant therapies to alleviate oxidative stress. This similarity of molecular mechanisms implies possible future attempts to reinforce each approach by repeating the same treatment approach at several stages of procurement and preservation, as well as utilizing these alternative approaches in tandem.展开更多
目的分析<2个月龄心脏死亡器官捐献(donation after cardiac death,DCD)供肝在婴幼儿肝移植中的临床疗效。方法回顾性分析2012年6月至2015年6月在天津市第一中心医院行肝移植的35例婴幼儿资料。其中,男21例,女14例;年龄范围为4~31个...目的分析<2个月龄心脏死亡器官捐献(donation after cardiac death,DCD)供肝在婴幼儿肝移植中的临床疗效。方法回顾性分析2012年6月至2015年6月在天津市第一中心医院行肝移植的35例婴幼儿资料。其中,男21例,女14例;年龄范围为4~31个月;胆道闭锁33例,Caroli病1例,Alagille综合征1例。35例患儿的供肝由中国人体器官分配与共享系统(COTRS)分配后获得,其中男21例,女14例,年龄范围为0.5~60.0个月,体重范围为3~18 kg。根据供体年龄将患儿分为两组,其中<2个月龄组(LT组)12例,≥2个月龄组(OT组)23例。收集所有患儿的住院资料、供者资料和随访信息。比较两组患儿术后并发症发生率,Kaplan-meier法分析两组患儿的生存情况。结果比较两组患儿和供者的资料,发现患儿的身高、体重,术后即刻血清丙氨酸转氨酶(ALT)、总胆红素(TBIL);供者的身高、体重及供肝质量、移植物受体体重比(graft to recipient weight ratio,GRWR)在两组间的差异具有统计学意义(P<0.05)。LT组中,肝动脉栓塞3例,门静脉狭窄1例,胆道并发症1例,术后肺感染3例,无急性排斥反应和EB病毒(Epstein-Barr virus,EBV)感染,巨细胞病毒(cytomegalovirus,CMV)感染1例。OT组中,肝动脉栓塞21.7%(5/23),门静脉狭窄26.1%(6/23),胆道并发症13.0%(3/23),术后肺感染34.8%(8/23),急性排斥反应17.4%(4/23),EBV感染34.8%(8/23),CMV感染39.1%(9/23)。两组患儿术后并发症发生率的差异无统计学意义(P>0.05);Kaplan-meier生存分析显示,LT组患儿1、3、5年累积生存率均为91.7%,OT组患儿1、3、5年累积生存率均为91.3%;两组间差异无统计学意义(χ2=0,P>0.05)。结论<2个月龄DCD供肝可用于婴幼儿肝移植,不增加术后并发症发生率,受者可获得满意远期生存。展开更多
基金This study was supported by a grant from Deutshcer Akademischer Austausch Dienst (DAAD) K. C. Wong Fellow-ships.
文摘Orthotopic liver transplantation as a successful treatment of end-stage liver disease is hampered by a persistent lack of cadaveric organs. Split liver transplantation, which was first successfully performed by Medical School of Hannover in 1988, has become a mature surgical technique to expand the donor pool. Between 1993 and 1999, split liver transplantation activities have increased in Europe from 1. 2% to 10. 4% in all performed liver transplantations. Current data have strongly supported that the survival rate of patients after split liver transplantation is not significantly different from that of patients after whole-size orthotopic liver transplantation. The most important step of donor graft selection is surgeon' s observation judged by the experience of individual transplant center. The paper aims to provide the guideline of donor selection, hepatic graft splitting, and recipient management as well. DATA SOURCES: Medical School of Hannover has accumulated plentiful experience of split liver transplantation for more than 10 cases ever since 1998. Besides that, we also reviewed a variety of literatures from other famous European and American centers specialized in this field for many years. RESULTS:According to our experience combined with the view points of others, the donor should meet the following criteria as well: (1) age less than 50 years; (2) hemodynamics stable; (3) ICU less than 5 days; (4) Na less than 170 mmol/L or better if less than 150 mmol/L. In 1996 and 1997, the Hamburg group and the UCLA group separately introduced a breakthrough technique performing split liver transplantation in situ. Evidently, the in situ technique has been limited by prolonged time of donor organ procurement , coordination with other organ procurement teams, and even extra burden on donor hospital. Some groups, therefore, have restored the ex situ or bench splitting technique , and fortunately the transplant outcomes of the ex situ technique are equivalent to those of the in situ one. Recently some new techniques h
基金Supported by Grants from the United States National Institutes of Health, R01DK59766 to Yarmush M R00DK080942 and R01DK096075 to Uygun K
文摘The shortage of donor livers has led to an increased use of organs from expanded criteria donors. Included are livers with steatosis, a metabolic abnormality that increases the likelihood of graft complications posttransplantation. After a brief introduction on the etiology, pathophysiology, categories and experimental models of hepatic steatosis, we herein review the methods to rescue steatotic donor livers before transplantation applied in clinical and experimental studies. The methods span the spectrum of encouraging donor weight loss, employing drug therapy, heat shock preconditioning, ischemia preconditioning and selective anesthesia on donors, and the treatment on isolated grafts during preservation. These methods work at different stages of transplantation process, although share similar molecular mechanisms including lipid metabolism stimulation through enzymes or nuclear receptor e.g. , peroxisomal proliferator-activated receptor, or anti-inflammation through suppressing cytokines e.g. , tumor necrosis factor-α, or antioxidant therapies to alleviate oxidative stress. This similarity of molecular mechanisms implies possible future attempts to reinforce each approach by repeating the same treatment approach at several stages of procurement and preservation, as well as utilizing these alternative approaches in tandem.
文摘目的分析<2个月龄心脏死亡器官捐献(donation after cardiac death,DCD)供肝在婴幼儿肝移植中的临床疗效。方法回顾性分析2012年6月至2015年6月在天津市第一中心医院行肝移植的35例婴幼儿资料。其中,男21例,女14例;年龄范围为4~31个月;胆道闭锁33例,Caroli病1例,Alagille综合征1例。35例患儿的供肝由中国人体器官分配与共享系统(COTRS)分配后获得,其中男21例,女14例,年龄范围为0.5~60.0个月,体重范围为3~18 kg。根据供体年龄将患儿分为两组,其中<2个月龄组(LT组)12例,≥2个月龄组(OT组)23例。收集所有患儿的住院资料、供者资料和随访信息。比较两组患儿术后并发症发生率,Kaplan-meier法分析两组患儿的生存情况。结果比较两组患儿和供者的资料,发现患儿的身高、体重,术后即刻血清丙氨酸转氨酶(ALT)、总胆红素(TBIL);供者的身高、体重及供肝质量、移植物受体体重比(graft to recipient weight ratio,GRWR)在两组间的差异具有统计学意义(P<0.05)。LT组中,肝动脉栓塞3例,门静脉狭窄1例,胆道并发症1例,术后肺感染3例,无急性排斥反应和EB病毒(Epstein-Barr virus,EBV)感染,巨细胞病毒(cytomegalovirus,CMV)感染1例。OT组中,肝动脉栓塞21.7%(5/23),门静脉狭窄26.1%(6/23),胆道并发症13.0%(3/23),术后肺感染34.8%(8/23),急性排斥反应17.4%(4/23),EBV感染34.8%(8/23),CMV感染39.1%(9/23)。两组患儿术后并发症发生率的差异无统计学意义(P>0.05);Kaplan-meier生存分析显示,LT组患儿1、3、5年累积生存率均为91.7%,OT组患儿1、3、5年累积生存率均为91.3%;两组间差异无统计学意义(χ2=0,P>0.05)。结论<2个月龄DCD供肝可用于婴幼儿肝移植,不增加术后并发症发生率,受者可获得满意远期生存。
