Optimization of surgical evaluation algorithms for living donor liver transplantation.

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2024-10-07 DOI:10.1016/j.dld.2024.09.018

Paul Kupke, Verena Schropp, Leonhard A Schurr, Ivor Dropco, Laura S Kupke, Markus Götz, Edward K Geissler, Hans J Schlitt, Jens M Werner

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引用次数: 0

Abstract

Background: Living donor liver transplantation (LDLT) is an established and endorsed alternative for deceased donor liver transplantation with better recipient outcomes. Nevertheless, while extensive evaluation of potential donors is crucial, evaluation algorithms differ between transplant centres and guidelines.

Methods: We included 317 individuals evaluated for LDLT between 07/2007-07/2022 in a retrospective analysis. The evaluation process was analysed to identify the key reasons for declining 77 potential donors. Additionally, 146 donors that underwent LDLT were analysed regarding risk factors for complications.

Results: The main reasons for donor refusal were liver volumetry (40.3 %) and metabolic factors including obesity or steatotic liver disease (20.8 %). Contrast-enhanced computed tomography (CECT) identified 63.6 % of all declined donors; CECT combined with assessment of medical history, physical examination, blood testing and ultrasonography, identified 87.0 % of declined potential donors. Associated with this selection, complication rates in donors were low (≥II in 17.1 %; none with ≥IVb). Notably, higher age was a risk factor for developing a complication ≥II after hemi-hepatectomy (p = 0.0373).

Conclusions: We propose a progressive 4-step evaluation algorithm that begins with a very basic assessment combined with up-front CECT. This early phase of testing is expected to identify nearly 90 % of ineligible donors, thereby conserving critical resources, time and money, as well as minimising burden for potential donors.

Funding: J.M.W. received funding by grant We-4675/6-1 from the Deutsche Forschungsgemeinschaft (DFG) in Bonn, Germany.

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活体肝移植手术评估算法的优化。

背景：活体肝移植（LDLT）是已确立并得到认可的已故供体肝移植的替代方案，可为受者带来更好的治疗效果。然而，虽然对潜在供体进行广泛评估至关重要，但不同移植中心和指南的评估算法各不相同：我们在一项回顾性分析中纳入了 2007 年 7 月至 2022 年 7 月期间接受 LDLT 评估的 317 人。我们对评估过程进行了分析，以确定拒绝 77 名潜在供体的主要原因。此外，还对 146 名接受 LDLT 的供体进行了并发症风险因素分析：拒绝捐献者的主要原因是肝脏体积测量（40.3%）和代谢因素，包括肥胖或脂肪肝（20.8%）。对比增强计算机断层扫描（CECT）确定了63.6%被拒绝的捐献者；CECT与病史评估、体格检查、血液检测和超声波检查相结合，确定了87.0%被拒绝的潜在捐献者。与这种选择相关的是，捐献者的并发症发生率较低（17.1%≥II 级；无≥IVb 级）。值得注意的是，年龄越大，半肝切除术后并发症≥II的风险越高（p = 0.0373）：我们提出了一个循序渐进的四步评估算法，首先进行非常基本的评估，并结合前期的 CECT。这一早期阶段的检测有望识别近 90% 不合格的捐献者，从而节约关键资源、时间和金钱，并最大限度地减轻潜在捐献者的负担：J.M.W.接受了德国波恩德国研究基金会（DFG）We-4675/6-1号基金的资助。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.