Tamura S, Sugawara Y, Kaneko J, Yamashiki N, Kishi Y, Matsui Y, Kokudo N, Makuuchi M.
人工器官和器官移植部，外科，医学系，器官移植服务，东京大学，东京，日本。

　　在活体肝移植（LDLT）领域，对如何评估捐赠者手术并发症的问题还缺乏共识，此外加上不连贯的数据累积，二者阻碍了活体肝移植疗效的比较。我们认为采用2004年Clavien提出的分级系统会对此有所帮助。

根据Clavien分级系统，我们分析了东京大学1996年1月至2005年10月期间243例成人捐赠者的手术并发症。该系统对各等级的定义如下：I级，与正常的术后情况有所偏差，但不需要治疗；II级，需要药物治疗的并发症；III级，需要通过手术、内窥镜或放射介入治疗的并发症（IIIa/b：不需要/需要全身麻醉）；IV级，威胁生命的并发症，需要重症特别护理；V级，死亡。

67例患者（28%）发生了手术并发症；无一例患者死亡。发生并发症的患者比例如下：I级36名（15%）；II级10名（4%）；IIIa级12名（5%）；IIIb级9名（4%）；IV级0例；V级0例。其中6名IIIb级患者因胆漏进行了手术修复。Clavien系统简单而详实，因此可以作为活体肝移植捐赠者疗效评估的常用工具。我们建议在讨论活体捐赠者手术并发症时使用Clavien系统。
Systematic grading of surgical complications in live liver donors according to Clavien's system
Tamura S, Sugawara Y, Kaneko J, Yamashiki N, Kishi Y, Matsui Y, Kokudo N, Makuuchi M.
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, Organ Transplantation Service, University of Tokyo, Tokyo, Japan.

The lack of consensus on how to evaluate surgical complications of donors in live donor liver transplantation (LDLT) and incoherence of cumulative data hampers efficient comparison of the outcome worldwide. We considered that the application of the internationally validated classification system introduced by Clavien in 2004 might be beneficial.

Operative complications of 243 patients who underwent live donor hepatectomy for adult LDLT between January 1996 and October 2005 at the University of Tokyo were analyzed according to the system. Definitions for each grade in the system are: grade I, deviation from the normal postoperative course but without the need for therapy; grade II, complication requiring pharmacologic treatment; grade III, complication with the need for surgical, endoscopic or radiological intervention (IIIa/b: without/with the need for general anesthesia); grade IV, life-threatening complication requiring intensive care; grade V, death.

Surgical morbidity was recognized in 67 donors (28%). No deaths occurred. The numbers of patients with complications were: grade I, 36 (15%); II, 10 (4%); IIIa, 12 (5%); IIIb, 9 (4%); IV, 0; V, 0. Six in IIIb underwent surgical repair for bile leakage. Clavien's system is simple and informative. It may serve as a common tool for the quality assessment in live liver donor surgery worldwide, and we propose its application whenever surgical complication of live donor is discussed.
Transpl Int. 2006 Dec;19(12):982-7.

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