Linkslaterale Leberlebendspende – Erfahrungen aus Essen

 

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Zusammenfassung

Hintergrund: Der bestehende Mangel an Spenderorganen zur Lebertransplantation zeigt sich insbesondere in der pädiatrischen Transplantationsmedizin und entsprechend steht hier die linkslaterale Leberlebendspende im Zentrum der Organspende. Die vorliegende Arbeit analysiert die durchgeführten linkslateralen Leberlebendspenden von Dezember 2008 bis Oktober 2012 am Universitätsklinikum Essen in Bezug auf die Spendersicherheit.

Methodik: In der vorliegenden Studie wurden alle linkslateralen Leberlebendspender von Dezember 2008 bis Oktober 2012 am Universitätsklinikum Essen eingeschlossen. Alle Operationen wurden offen über eine begrenzte mediale Längslaparotomie durchgeführt. Neben der Analyse von Standardspenderdaten wurden alle Komplikationen erfasst und nach ihrer Relevanz klassifiziert.

Ergebnisse: Am Universitätsklinikum Essen wurden zwischen Dezember 2008 und Oktober 2012 35 linkslaterale Leberlebendspenden durchgeführt. Das Spenderalter betrug 31,9 (23,4–61,7) Jahre, und 60 % waren weiblich. Relevante Vorerkrankungen lagen nicht vor. Die Operationszeit lag bei 180 (± 89) Minuten. Die Überlebensrate betrug 100 %. Geringgradige Komplikationen wurden in 1 von 35 Patienten dokumentiert. Am 1. postoperativen Tag zeigte sich ein Peak der Transaminasen, der sich im Verlauf normalisierte. Der postoperative Krankenhausaufenthalt betrug 7 (5–11) Tage.

Schlussfolgerung: Die linkslaterale Leberlebendspende ist ein sehr sicheres Verfahren, das nach geeigneter Spenderauswahl an entsprechenden Zentren genutzt werden kann, um den Spenderpool für pädiatrische Patienten zu erweitern.

Abstract

Background: The international organ shortage for liver transplantation exists particularly in paediatric transplantation. Therefore left-lateral living related liver donation (LLRLD) plays a major role in this field. The aim of the present study was to analyse all procedures of LLRLD in terms of donor safety from December 2008 to October 2012 at the University Hospital of Essen, Germany.

Methods: All procedures of LLRLD from December 2008 to October 2012 at the University Hospital of Essen were included in the present study. All operations were carried out via an open narrowed median longitudinal laparotomy. General donor data were analysed. Complications were recorded and classified in accordance to their relevance.

Results: 35 LLRLD were performed between December 2008 and October 2012 at the University Hospital of Essen, Germany. Mean age of the donors was 31.9 (23.4–61.7) years and 60 % were female. Past medical histories of the donors showed no relevant diagnoses. Mean length of the surgical procedure was 180 (± 89) minutes. Survival rate was 100 %. Minor complications were seen in 1 of 35 patients. Laboratory data showed a peak of the transaminases on the first postoperative day which resolved during the further course. Median postoperative hospital stay was 7 (5–11) days.

Conclusion: LLRLD can be performed safely for the donors after adequate donor selection. The organ pool for paediatric recipients can be expanded by this procedure at suitable transplant centres.

• Literatur

• Research Group SPLIT. Studies of Pediatric Liver Transplantation (SPLIT): Year 2000 Outcomes. Transplantation 2001; 72: 463-476
  CrossrefPubMedGoogle Scholar
• Vagefi PA, Parekh J, Ascher NL. et al. Outcomes with split liver transplantation in 106 recipients. Arch Surg 2011; 146: 1052-1059
  CrossrefPubMedGoogle Scholar
• Broelsch CE, Emond JC, Thistlethwaite JR. et al. Liver transplantation, including the concept of reduced-size liver transplants in children. Ann Surg 1988; 208: 410-420
  CrossrefPubMedGoogle Scholar
• Broelsch CE, Emond J, Whitington PF. et al. Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants. Ann Surg 1990; 212: 368-375
  CrossrefPubMedGoogle Scholar
• Emond JC, Whitington PF, Thistlethwaite JR. et al. Transplantation of two patients with one liver. Analysis of a preliminary experience with “Split-liver” grafting. Ann Surg 1990; 212: 14-22
  CrossrefPubMedGoogle Scholar
• Broelsch CE, Whitington PF, Emond JC. et al. Liver transplantation in children. Ann Surg 1991; 214: 428-437
  CrossrefPubMedGoogle Scholar
• Dindo D, Demartines N, Clavien PA. Classification of surgical complications. Ann Surg 2004; 240: 205-213
  CrossrefPubMedGoogle Scholar
• Schulze M, Dresske B, Deinzer J. et al. Implications for the usage of the left lateral liver graft for infants ≤ 10 kg, irrespective of a large-for-size situation–are monosegmental grafts redundant?. Transpl Int 2011; 24: 797-804
  CrossrefPubMedGoogle Scholar
• Im Internet. www.bmg.bund.de § 3 + §4 TPG Stand Oktober 2012.
  PubMedGoogle Scholar
• Im Internet. www.bmg.bund.de § 8 Abs. 1 TPG Stand Oktober 2012.
  PubMedGoogle Scholar
• Erim Y, Beckmann M, Gerken G. et al. Psychosomatic aspects of living donor liver transplantation. Chirurg 2010; 81: 820-825
  CrossrefPubMedGoogle Scholar
• Al-Shurafa H, Jawdat M, Wali S. et al. Donor experience and outcome of pediatric living-related liver transplantation in Saudi Arabia. J Hepatobiliary Pancreat Surg 2003; 10: 428-431
  CrossrefPubMedGoogle Scholar
• Miyagi S, Kawagishi N, Fujimori K. et al. Risks of donation and quality of donorsʼ life after living donor liver transplantation. Transpl Int 2005; 18: 47-51
  CrossrefPubMedGoogle Scholar
• Schroeder T, Radtke A, Kuehl H. et al. Evaluation of living liver donors with an all-inclusive 3D Multi-Detector Row CT protocol. Radiology 2006; 238: 900-910
  CrossrefPubMedGoogle Scholar
• Belghiti J, Kabbej M, Sauvanet A. et al. Drainage after elective hepatic resection. Ann Surg 1993; 218: 748-753
  CrossrefPubMedGoogle Scholar
• Liu CL, Fan ST, Lo CM. et al. Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg 2004; 239: 194-201
  CrossrefPubMedGoogle Scholar
• Umeshita K, Fujiwara K, Kiyosawa K. et al. Operative morbidity of living liver donors in Japan. Lancet 2003; 362: 687-690
  CrossrefPubMedGoogle Scholar
• Renz JF, Roberts JP. Long-term complications of living donor liver transplantation. Liver Transpl 2000; 6: S73-S76
  CrossrefPubMedGoogle Scholar
• Kousoulas L, Becker T, Richter N. et al. Living donor liver transplantation: effect of the type of liver graft donation on donor mortality and morbidity. Transpl Int 2011; 24: 251-258
  CrossrefPubMedGoogle Scholar
• Grewal HP, Thistlewaite JR, Loss GE. et al. Complications in 100 living-liver donors. Ann Surg 1998; 228: 214-219
  CrossrefPubMedGoogle Scholar
• Heise M, Jandt K, Rauchfuss F. et al. Managment of complications after liver resection. Zentralbl Chir 2010; 135: 112-120
  Article in Thieme ConnectPubMedGoogle Scholar
• Soejima Y, Shirabe K, Taketomi A. et al. Left lobe living donor liver transplantation in adults. Am J Transplant 2012; 12: 1877-1885
  PubMedGoogle Scholar
• Ishizaki Y, Kawasaki S, Sugo H. et al. Left lobe adult-to-adult living donor liver transplantation: should portal inflow modulation be added?. Liver Transpl 2012; 18: 305-314
  CrossrefPubMedGoogle Scholar
• Brown RS, Russo MW, Lai M. et al. A survey of liver transplantation from living adult donors in the United States. N Engl J Med 2003; 348: 818-825
  CrossrefPubMedGoogle Scholar
• Ghobrial RM, Freise CE, Trotter JF. et al. Donor morbidity after living donation for liver transplantation. Gastroenterology 2008; 135: 468-476
  CrossrefPubMedGoogle Scholar
• Beavers KL, Sandler RS, Shrestha R. Donor morbidity associated with right lobectomy for living donor liver transplantation to adult recipients: a systematic review. Liver Transpl 2002; 8: 110-117
  CrossrefPubMedGoogle Scholar
• Ringe B, Strong RW. The dilemma of living liver donor death: to report or not to report?. Transplantation 2008; 85: 790-793
  CrossrefPubMedGoogle Scholar
• Lee SG. Asian contribution to living donor liver transplantation. J Gastroenterol Hepatol 2006; 21: 572-574
  CrossrefPubMedGoogle Scholar
• Sotiropoulos GC, Radtke A, Molmenti EP. et al. Long-term follow-up after right hepatectomy for adult living donation and attitudes toward the procedure. Ann Surg 2011; 254: 694-701
  CrossrefPubMedGoogle Scholar
• Parikh ND, Ladner D, Abecassis M. et al. Quality of life for donors after living donor liver transplantation: a review of the literature. Liver Transpl 2010; 16: 1352-1358
  CrossrefPubMedGoogle Scholar