Dondero F, Farges O, Belghiti J, Francoz C, Sommacale D, Durand F, Sauvanet A, Janny S, Varma D, Vilgrain V.
肝胆外科，巴黎Beaujon医院，100 Bd du Général Leclerc，92118克里奇，法国。

在西方国家，捐赠者面临的风险是影响活体肝移植发展的主要障碍。关于捐赠者发病率的认识主要来自于对各种有关并发症文献的回顾性分析。对供者的转归没有进行前瞻性的分析。从1995年起，研究人员就对127例活体肝切除的术中和术后情况进行了前瞻性分析，并将结果记录了下来。

我们根据手术程度对所有的不良事件进行分类分层，包括45例肝左外叶部分切除术（LLS）；25例左肝切除（LH）和57例右肝切除（RH）。没有出现捐赠者死亡的案例。重症并发症的总体发病率为20%，范围是LH发病率为8%，RH发病率为32%。手术并发症概率、再次手术概率和多次入院概率分别为8%、3%和5%。但是，预期的不良事件数量显示总体术后发病率为51%，范围是LH发病率为32%，RH发病率为66%。

总之，活体肝移植捐赠术后不良事件的发病率接近50%。这些结果为潜在的捐赠者提供了更准确的信息。本研究证明，右肝切除中并发症的发病率比左肝切除高三倍，因此导致了对成人左肝切除的重新评估。

A prospective analysis of living-liver donation shows a high rate of adverse events
Dondero F, Farges O, Belghiti J, Francoz C, Sommacale D, Durand F, Sauvanet A, Janny S, Varma D, Vilgrain V.
Department of Hepatobiliary Surgery, University Paris 7 Beaujon Hospital, 100 Bd du Général Leclerc, 92118 Clichy, France.

Donor risk is the main obstacle in the development of living-donor liver transplantation in Western countries. The knowledge of a wide and uneven range of donor morbidity has come mainly from various retrospective analyses of complications in the literature. Donor outcomes have not been prospectively analyzed. From 1995, the intra- and postoperative courses of 127 living-donor hepatectomies were prospectively analyzed and recorded.

All adverse events were classified and stratified according to the extent of surgery, including 45 left-lateral sectionectomies (LLS); 25 left hepatectomies (LH), and 57 right hepatectomies (RH). There was no donor death. The overall rate of significant complications was 20%, ranging from 8% after LH to 32% after RH. The overall incidences of surgical complications, reoperations, and hospital readmissions were 8%, 3%, and 5%, respectively. However, the prospective accumulation of all adverse events revealed an overall postoperative morbidity of 51%, ranging from 32% after LH to 66% after RH.

In conclusion the incidence of postoperative adverse events after living donation is nearly 50% as revealed by prospective screening. These results allow more accurate information for potential donors. This study confirms that right hepatectomy carries three times higher risk of morbidity as compared to left-sided resections, leading to reappraisal of the use of left grafts in adults.

J Hepatobiliary Pancreat Surg. 2006;13(2):117-22.
PMID: 16547672 [PubMed - indexed for MEDLINE

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