Huang Mingzhu,Lu Ying,Lin Dongni,et al.Systematic review of safety and quality of life of living liver donors[J].Journal of Clinical Pediatric Surgery,2023,22(05):490-495.[doi:10.3760/cma.j.cn101785-202208019-017]
活体肝移植供肝者手术安全及术后生活质量研究进展
- Title:
- Systematic review of safety and quality of life of living liver donors
- 摘要:
- 肝移植已成为终末期肝病的有效治疗方案,其中活体肝移植(living donor liver transplantation,LDLT)是临床肝移植(liver transplantation,LT)的重要组成部分,也是我国儿童肝移植的主要手术方式。LDLT的大力发展可相对缓解供肝短缺的现状,扩大供肝池,使等待中的受体及时获得治疗。但与此同时,LDLT也会将健康的供体暴露于手术风险之中,对其术后生活质量造成影响。因此,本文在全面回顾相关文献及结合临床实践的基础上,就活体肝移植供肝者的手术安全(死亡风险、并发症发生率及手术安全的影响因素)及术后生活质量(总体概况、躯体症状、心理状况及工作与运动)进行综述,为临床上供体的选择与决策以及供体的围手术期管理提供理论依据。
- Abstract:
- Living donor liver transplantation (LDLT) is an integral part of clinical liver transplantation (LT).It has been a major choice of pediatric LT in mainland China.Though LDLT may expand the donor liver pool and save life for recipients on a waiting list.Also it puts healthy donors at the risk of surgery and affect their postoperative quality-of-life.Through a literature review,donor safety (mortality & complications) and quality-of-life post-donation (physical symptoms,psychological status & employment status,etc) were discussed for providing theoretical rationales for donor selection,decision-making and postoperative nursing.
参考文献/References:
[1] 夏强,朱欣烨.儿童肝移植发展现状及展望[J].临床小儿外科杂志,2022,21(5):401-404.DOI:10.3760/cma.j.cn101785-202202028-001. Xia Q,Zhu XY.Current developments and future outlooks of pediatric liver transplantation[J].J Clin Ped Sur,2022,21(5):401-404.DOI:10.3760/cma.j.cn101785-202202028-001.
[2] Mogul DB,Luo X,Bowring MG,et al.Fifteen-year trends in pediatric liver transplants:split,whole deceased,and living donor grafts[J].J Pediatr,2018,196:148-153.e2.DOI:10.1016/j.jpeds.2017.11.015.
[3] Mogul DB,Lee J,Purnell TS,et al.Barriers to access in pediatric living-donor liver transplantation[J].Pediatr Transplant,2019,23(6):e13513.DOI:10.1111/petr.13513.
[4] 中华医学会器官移植学分会.中国儿童肝移植操作规范(2019版)[J].中华移植杂志(电子版),2019,13(3):181-186.DOI:10.3877/cma.j.issn.1674-3903.2019.03.005. Branch of Organ Transplantation,Chinese Medical Association:Technical Specifications for Pediatric Liver Transplantation in China (2019 Edition)[J].Chin J Transplant (Electron Ed),2019,13(3):181-186.DOI:10.3877/cma.j.issn.1674-3903.2019.03.005.
[5] Miller C,Florman S,Kim-Schluger L,et al.Fulminant and fatal gas gangrene of the stomach in a healthy live liver donor[J].Liver Transpl,2004,10(10):1315-1319.DOI:10.1002/lt.20227.
[6] Dew MA,Butt Z,Humar A,et al.Long-term medical and psychosocial outcomes in living liver donors[J].Am J Transplant,2017,17(4):880-892.DOI:10.1111/ajt.14111.
[7] Muzaale AD,Dagher NN,Montgomery RA,et al.Estimates of early death,acute liver failure,and long-term mortality among live liver donors[J].Gastroenterology,2012,142(2):273-280.DOI:10.1053/j.gastro.2011.11.015.
[8] Cheah YL,Simpson MA,Pomposelli JJ,et al.Incidence of death and potentially life-threatening near-miss events in living donor hepatic lobectomy:a world-wide survey[J].Liver Transpl,2013,19(5):499-506.DOI:10.1002/lt.23575.
[9] R?ssler F,Sapisochin G,Song G,et al.Defining benchmarks for major liver surgery:a multicenter analysis of 5202 living liver donors[J].Ann Surg,2016,264(3):492-500.DOI:10.1097/SLA.0000000000001849.
[10] Lauterio A,Di Sandro S,Gruttadauria S,et al.Donor safety in living donor liver donation:an Italian multicenter survey[J].Liver Transpl,2017,23(2):184-193.DOI:10.1002/lt.24651.
[11] Lee JG,Lee KW,Kwon CHD,et al.Donor safety in living donor liver transplantation:the Korean organ transplantation registry study[J].Liver Transpl,2017,23(8):999-1006.DOI:10.1002/lt.24778.
[12] Meng HP,Yang JY,Yan LN.Donor safety in adult-adult living donor liver transplantation:a single-center experience of 356 cases[J].Med Sci Monit,2016,22:1623-1629.DOI:10.12659/msm.898440.
[13] Ozgor D,Dirican A,Ates M,et al.Donor complications among 500 living donor liver transplantations at a single center[J].Transplant Proc,2012,44(6):1604-1607.DOI:10.1016/j.transproceed.2012.04.002.
[14] Nydam TL,Reddy MS,Pomfret EA,et al.Progression of living liver donation worldwide[J].Curr Opin Organ Transplant,2018,23(2):162-168.DOI:10.1097/MOT.0000000000000516.
[15] Narasimhan G,Safwan M,Kota V,et al.Donor outcomes in living donor liver transplantation-analysis of 275 donors from a single centre in India[J].Transplantation,2016,100(6):1251-1256.DOI:10.1097/TP.0000000000001246.
[16] Benzing C,Schmelzle M,Oellinger R,et al.Living-donor liver transplant:an analysis of postoperative outcome and health-related quality of life in liver donors[J].Exp Clin Transplant,2018,16(5):568-574.DOI:10.6002/ect.2017.0108.
[17] Yankol Y,Mecit N,Kanmaz T,et al.Complications and outcomes of 890 living liver donor hepatectomies at a single center:risks of saving loved one’s life[J].Turk J Surg,2020,36(2):192-201.DOI:10.5578/turkjsurg.4548.
[18] Yan C,Li BH,Sun XT,et al.Laparoscopic hepatectomy is superior to open procedures for hepatic hemangioma[J].Hepatobiliary Pancreat Dis Int,2021,20(2):142-146.DOI:10.1016/j.hbpd.2020.09.001.
[19] Liu QQ,Liu F,Ding JJ,et al.Surgical outcomes and quality of life between laparoscopic and open approach for hepatic hemangioma:a propensity score matching analysis[J].Medicine (Baltimore),2019,98(6):e14485.DOI:10.1097/MD.0000000000014485.
[20] Li L,Xu LL,Wang P,et al.Advantages of laparoscopic hepatic hemangioma surgery in quality of life:a prospective study[J].Surg Endosc,2022,36(12):8967-8974.DOI:10.1007/s00464-022-09348-x.
[21] Olthoff KM.Hepatic regeneration in living donor liver transplantation[J].Liver Transpl,2003,9(10 Suppl 2):S35-S41.DOI:10.1053/jlts.2003.50229.
[22] Patel S,Orloff M,Tsoulfas G,et al.Living-donor liver transplantation in the United States:identifying donors at risk for perioperative complications[J].Am J Transplant,2007,7(10):2344-2349.DOI:10.1111/j.1600-6143.2007.01938.x.
[23] Dayangac M,Taner CB,Yaprak O,et al.Utilization of elderly donors in living donor liver transplantation:when more is less?[J].Liver Transpl,2011,17(5):548-555.DOI:10.1002/lt.22276.
[24] Yoshino K,Taura K,Ikeno Y,et al.Long-term impact and clinical significance of living donor liver transplantation with respect to donor liver restoration and spleen size:a prospective study[J].Am J Transplant,2020,20(3):808-816.DOI:10.1111/ajt.15627.
[25] Jalil S,Black SM,Washburn K,et al.Trends and health care outcomes among living liver donors:are we ready to expand the donor pool with living liver donations?[J].Liver Transpl,2021,27(11):1603-1612.DOI:10.1002/lt.26223.
[26] Kadohisa M,Inomata Y,Uto K,et al.Impact of donor age on the outcome of living-donor liver transplantation:special consideration to the feasibility of using elderly donors[J].Transplantation,2021,105(2):328-337.DOI:10.1097/TP.0000000000003246.
[27] Kim SH,Lee EC,Shim JR,et al.Right lobe living donors ages 55 years old and older in liver transplantation[J].Liver Transpl,2017,23(10):1305-1311.DOI:10.1002/lt.24823.
[28] de Meijer VE,Kalish BT,Puder M,et al.Systematic review and meta-analysis of steatosis as a risk factor in major hepatic resection[J].Br J Surg,2010,97(9):1331-1339.DOI:10.1002/bjs.7194.
[29] Nagai S,Fujimoto Y,Kamei H,et al.Mild hepatic macrovesicular steatosis may be a risk factor for hyperbilirubinaemia in living liver donors following right hepatectomy[J].Br J Surg,2009,96(4):437-444.DOI:10.1002/bjs.6479.
[30] Yamamoto K,Takada Y,Fujimoto Y,et al.Nonalcoholic steatohepatitis in donors for living donor liver transplantation[J].Transplantation,2007,83(3):257-262.DOI:10.1097/01.tp.0000250671.06456.3f.
[31] 高伟.扩大儿童肝脏移植供体来源途径[J].临床小儿外科杂志,2022,21(5):405-409.DOI:10.3760/cma.j.cn101785-202203014-002. Gao W.Expanding the sources of donor pool for pediatric liver transplantation[J].J Clin Ped Sur,2022,21(5):405-409.DOI:10.3760/cma.j.cn101785-202203014-002.
[32] Yoon YI,Song GW,Lee SG,et al.Safe use of right lobe living donor livers with moderate steatosis in adult-to-adult living donor liver transplantation:a retrospective study[J].Transpl Int,2021,34(5):872-881.DOI:10.1111/tri.13859.
[33] Miller CM,Durand F,Heimbach JK,et al.The international liver transplant society guideline on living liver donation[J].Transplantation,2016,100(6):1238-1243.DOI:10.1097/TP.0000000000001247.
[34] Manas D,Burnapp L,Andrews PA.Summary of the British Transplantation Society UK guidelines for living donor liver transplantation[J].Transplantation,2016,100(6):1184-1190.DOI:10.1097/TP.0000000000001128.
[35] Kim SH,Kim YK,Lee SD,et al.Selection and outcomes of living donors with a remnant volume less than 30% after right hepatectomy[J].Liver Transpl,2013,19(8):872-878.DOI:10.1002/lt.23677.
[36] Abu Hilal M,Aldrighetti L,Dagher I,et al.The Southampton consensus guidelines for laparoscopic liver surgery:from indication to implementation[J].Ann Surg,2018,268(1):11-18.DOI:10.1097/SLA.0000000000002524.
[37] Samstein B,Griesemer A,Cherqui D,et al.Fully laparoscopic left-sided donor hepatectomy is safe and associated with shorter hospital stay and earlier return to work:a comparative study[J].Liver Transpl,2015,21(6):768-773.DOI:10.1002/lt.24116.
[38] Cherqui D,Ciria R,Kwon CHD,et al.Expert consensus guidelines on minimally invasive donor hepatectomy for living donor liver transplantation from innovation to implementation:a joint initiative from the International Laparoscopic Liver Society (ILLS) and the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA)[J].Ann Surg,2021,273(1):96-108.DOI:10.1097/SLA.0000000000004475.
[39] Park JH,Suh S,Hong SK,et al.Pure laparoscopic versus open right donor hepatectomy including the middle hepatic vein:a comparison of outcomes and safety[J].Ann Surg Treat Res,2022,103(1):40-46.DOI:10.4174/astr.2022.103.1.40.
[40] Lincango Naranjo EP,Garces-Delgado E,Siepmann T,et al.Robotic living donor right hepatectomy:a systematic review and meta-analysis[J].J Clin Med,2022,11(9):2603.DOI:10.3390/jcm11092603.
[41] Schulze M,Elsheikh Y,Boehnert MU,et al.Robotic surgery and liver transplantation:a single-center experience of 501 robotic donor hepatectomies[J].Hepatobiliary Pancreat Dis Int,2022,21(4):334-339.DOI:10.1016/j.hbpd.2022.05.006.
[42] Weng LC,Huang HL,Lee WC,et al.Health-related quality of life of living liver donors 1 year after donation[J].Hepatobiliary Surg Nutr,2019,8(1):1-9.DOI:10.21037/hbsn.2018.11.10.
[43] Udomsin K,Lapisatepun W,Chotirosniramit A,et al.Adult-to-adult living donor liver transplantation:postoperative outcomes and quality of life in liver donors:first report in Thailand[J].Transplant Proc,2019,51(8):2761-2765.DOI:10.1016/j.transproceed.2019.03.080.
[44] Raza MH,Kim MH,Ding L,et al.Long-term financial,psychosocial,and overall health-related quality of life after living liver donation[J].J Surg Res,2020,253:41-52.DOI:10.1016/j.jss.2020.03.025.
[45] Ladner DP,Dew MA,Forney S,et al.Long-term quality of life after liver donation in the adult to adult living donor liver transplantation cohort study (A2ALL)[J].J Hepatol,2015,62(2):346-353.DOI:10.1016/j.jhep.2014.08.043.
[46] Janik MK,Ksi??opolska A,Kostrzewa K,et al.Long-term health-related quality of life in living liver donors[J].Ann Transplant,2019,24:45-51.DOI:10.12659/AOT.911109.
[47] Hesimov I,Kirimker EO,Duman B,et al.Health-related quality of life of liver donors:a prospective longitudinal study[J].Transplant Proc,2018,50(10):3076-3081.DOI:10.1016/j.transproceed.2018.07.018.
[48] Humphreville VR,Radosevich DM,Humar A,et al.Longterm health-related quality of life after living liver donation[J].Liver Transpl,2016,22(1):53-62.DOI:10.1002/lt.24304.
[49] 靳曙光,向波,杨家印,等.儿童肝移植术后供体生活质量分析[J].中华小儿外科杂志,2016,37(5):356-360.DOI:10.3760/cma.j.issn.0253-3006.2016.05.008. Jin SG,Xiang B,Yang JY,et al.Analysis of health-related quality-of-life in donors of pediatric liver transplantation[J].Chin J Pediatr Surg,2016,37(5):356-360.DOI:10.3760/cma.j.issn.0253-3006.2016.05.008.
[50] 沈丛欢,陶一峰,李瑞东,等.儿童活体肝移植供体术后生活质量评估[J].肝胆外科杂志,2017,25(5):332-335.DOI:10.3969/j.issn.1006-4761.2017.05.006. Shen CH,Tao YF,Li RD,et al.Quality-of-life of donors after pediatric living donor liver transplantation[J].J Hepatobiliary Surg,2017,25(5):332-335.DOI:10.3969/j.issn.1006-4761.2017.05.006.
[51] Holtzman S,Clarke HA,McCluskey SA,et al.Acute and chronic postsurgical pain after living liver donation:Incidence and predictors[J].Liver Transpl,2014,20(11):1336-1346.DOI:10.1002/lt.23949.
[52] Butt Z,DiMartini AF,Liu Q,et al.Fatigue,pain,and other physical symptoms of living liver donors in the adult-to-adult living donor liver transplantation cohort study[J].Liver Transpl,2018,24(9):1221-1232.DOI:10.1002/lt.25185.
[53] Dew MA,DiMartini AF,Ladner DP,et al.Psychosocial outcomes 3 to 10 years after donation in the adult to adult living donor liver transplantation cohort study[J].Transplantation,2016,100(6):1257-1269.DOI:10.1097/TP.0000000000001144.
[54] LaPointe Rudow D,DeLair S,Feeley T,et al.Longterm impact of living liver donation:a self-report of the donation experience[J].Liver Transpl,2019,25(5):724-733.DOI:10.1002/lt.25402.
[55] Shen CJ,Huang HL,Chen KH,et al.Comparison of liver function,emotional status,and quality of life of living liver donors in Taiwan[J].Transplant Proc,2016,48(4):1007-1011.DOI:10.1016/j.transproceed.2015.11.022.
[56] Dew MA,Butt Z,Liu Q,et al.Prevalence and predictors of patient-reported long-term mental and physical health after donation in the adult-to-adult living-donor liver transplantation cohort study[J].Transplantation,2018,102(1):105-118.DOI:10.1097/TP.0000000000001942.
[57] Lee JM,Shehta A,Lee KW,et al.Donor wound satisfaction after living-donor liver transplantation in the era of pure laparoscopic donor hepatectomy[J].Surg Endosc,2021,35(5):2265-2272.DOI:10.1007/s00464-020-07640-2.
[58] Kim WJ,Kim KH,Cho HD,et al.Long-term safety and efficacy of pure laparoscopic donor hepatectomy in pediatric living donor liver transplantation[J].Liver Transpl,2021,27(4):513-524.DOI:10.1002/lt.25910.
[59] 罗毅,朱建军,赵东,等.全腹腔镜供肝获取儿童亲属活体肝移植的临床疗效分析[J].中华器官移植杂志,2019,40(1):26-30.DOI:10.3760/cma.j.issn.0254-1785.2019.01.007. Luo Y,Zhu JJ,Zhao D,et al.Clinical efficacy of whole laparoscopic lobehepatectomy for living donor pediatric liver transplantation[J].Chin J Organ Transplant,2019,40(1):26-30.DOI:10.3760/cma.j.issn.0254-1785.2019.01.007.
相似文献/References:
[1]杨振宇,陈福真,李滨,等.小儿亲体部分肝移植治疗肝母细胞瘤(附1例报告)[J].临床小儿外科杂志,2007,6(02):12.
[2]唐艳,刘洋,王紫娟,等. 个体化干预模式在儿童肝移植受者术后随访中的应用[J].临床小儿外科杂志,2016,15(01):41.
[3]余晨,詹江华,高伟,等.胆道闭锁Ｋａｓａｉ术后肝移植患儿不同自体肝生存的临床与病理分析[J].临床小儿外科杂志,2017,16(06):552.
[4]王川,李亚楠,向波,等.婴幼儿血管瘤生活质量专用量表的信度与效度检验及其临床应用[J].临床小儿外科杂志,2019,18(08):635.[doi:10.3969/j.issn.1671-6353.2019.08.004]
Wang Chuan,Li Yanan,Xiang Bo,et al.Measuring reliability and validity of a Chinese mandarin version quality-of-life instrument for infantile hemangioma and its clinical application[J].Journal of Clinical Pediatric Surgery,2019,18(05):635.[doi:10.3969/j.issn.1671-6353.2019.08.004]
[5]彭宇明,司中州,袁妙贤,等.儿童肝移植20例诊治分析[J].临床小儿外科杂志,2019,18(08):681.[doi:10.3969/j.issn.1671-6353.2019.08.013]
Peng Yuming,Si Zhongzhou,Yuan Miaoxian,et al.Diagnoses and treatments of hepatic transplantation in 20 children[J].Journal of Clinical Pediatric Surgery,2019,18(05):681.[doi:10.3969/j.issn.1671-6353.2019.08.013]
[6]王焕民.开展新技术 提高儿童肝胆肿瘤手术治疗水平[J].临床小儿外科杂志,2020,19(05):377.[doi:10.3969/j.issn.1671-6353.2020.05.001]
Wang Huanmin.Adopting new technology to optimize the surgical treatment of hepatobiliary cancer in children[J].Journal of Clinical Pediatric Surgery,2020,19(05):377.[doi:10.3969/j.issn.1671-6353.2020.05.001]
[7]董岿然.联合肝脏离断和门静脉结扎二步肝切除术在儿童肝肿瘤治疗中的应用[J].临床小儿外科杂志,2020,19(05):382.[doi:10.3969/j.issn.1671-6353.2020.05.002]
Dong Kuiran.Application of associated liver partition and portal vein ligation for staged hepatectomy in the treatment of liver tumors in children[J].Journal of Clinical Pediatric Surgery,2020,19(05):382.[doi:10.3969/j.issn.1671-6353.2020.05.002]
[8]郑珊.胆道闭锁患儿获得长期生存需要关注的问题[J].临床小儿外科杂志,2020,19(06):469.[doi:10.3969/j.issn.1671-6353.2020.06.001]
Zheng Shan.Several outstanding issues in long-term survival of children with biliary atresia[J].Journal of Clinical Pediatric Surgery,2020,19(05):469.[doi:10.3969/j.issn.1671-6353.2020.06.001]
[9]沈秋龙,陈亚军,彭春辉,等.肝脏硬度测量值预测胆道闭锁术后五年自体肝生存的价值研究[J].临床小儿外科杂志,2020,19(06):486.[doi:10.3969/j.issn.1671-6353.2020.06.005]
Shen Qiulong,Chen Yajun,Peng Chunhui,et al.Predicting five-year native liver survival after Kasai procedure of biliary atresia by liver stiffness measurement[J].Journal of Clinical Pediatric Surgery,2020,19(05):486.[doi:10.3969/j.issn.1671-6353.2020.06.005]
[10]隆琦,钭金法,陈菲,等.胆道闭锁Kasai术后自体肝生存良好患儿的营养状况调查[J].临床小儿外科杂志,2020,19(06):491.[doi:10.3969/j.issn.1671-6353.2020.06.006]
Long Qi,Tou Jinfa,Chen Fei,et al.Nutritional status of children with biliary atresia surviving well after Kasai surgery[J].Journal of Clinical Pediatric Surgery,2020,19(05):491.[doi:10.3969/j.issn.1671-6353.2020.06.006]
备注/Memo
收稿日期:2022-8-9。
通讯作者:任雪飞,Email:renxuefei@renji.com