活体肝移植供体选择与思考.pptVIP

活体肝移植供体选择及思考 Asian contribution to living donor liver transplantation The first successful adult ldlt using a left-lobe graft was reported by Makuuchi et al. from Japan in 1994. To overcome the barrier of graft-size matching for adult patients with use of a left-lobe graft, a trial of adult ldlt using a right-lobe graft with middle hepatic vein was reported with satisfactory outcome by Fan et al. From hong kong in 1997. Lee et al. From korea initiated modified right-lobe liver grafting with interposition vein grafts to drain anterior segment and two left-lobe liver grafting to overcome graft-size insufficiency and to ensure donor safety in 1999 and 2000, respectively. In addition to technical innovations, indications for liver transplantation have been developed by asian centers as LDLT activity has increased. 重症肝炎？ 重症肝炎实施LDLT可能需要快速的决定和评估，影响供体的真实决定 有的中心，不做重症肝炎LDLT LDLT for HCC or CCA？ Patients with hepatocellular carcinoma (HCC) are the best candidates for LDLT because the operation could be done earlier especially for patients who are disadvantaged by allocation algorithm for grafts from deceased donors.  -Cheng SJ, et al. Living-donor versus cadaveric liver transplantation for non-resectable small hepatocellular carcinoma and compensated cirrhosis: a decision analysis. Transplantation; 2001: 72: 861 Survival following resection for CCA is 20% to 40% at 5 years. Survival following liver transplantation for unresectable, perihilar CCAs, mass lesion if present 3 cm, is greater than 80% at 5 years. Patients with intrahepatic CCAs are not eligible for liver transplantation.  -Heimbach JK, et al. Transplantation for hilar cholangio-carcinoma. Liver Transpl. 2004; 10(10 Suppl 2):S65-8. 供体选择标准 绝对自愿，无任何利益报酬期望； 一般要求年龄在18-60岁之间，性别和种族没有严格要求； 活体肝移植供体必须身体健康，没有高血压、糖尿病、心脏病、恶性肿瘤和其它传染病； 活体肝移植又称亲体肝移植，多在亲属间形成供受体关系，包括（1）（三代以内）血缘关系亲属，供肝者包括直系亲属父母、兄弟姐妹和18岁以上的子女，其他亲属如姑妈、姨妈、叔伯、舅父、堂表兄弟姐妹、同父异母或同母异父兄弟姐妹、侄子女或外甥子女等；（2）非血缘关系活体肝移植最多见于夫妻间，其他姻亲亲属、朋友、同事、邻居或其他熟人