钥匙成功的Live Donor成人肝移植计划

One of the greatest challenges facing patients who require a liver transplant is surviving the wait for a donor organ. Each year, nearly 16,000 patients in the United States are on the liver transplant waiting list, according to UNOS; yet only between 5,000 and 6,000 receive a transplant from a deceased donor.¹Zakiyah Kadry，MD说,“尽管patie肝脏移植手术nts are stratified based on MELD scores, some die while waiting. To decrease wait times and associated mortality, some patients can receive grafts from live donors.”

In 2011, only 247 live donor liver transplants were performed in the United States, according to HRSA/ OPTN statistics.²“Live donor programs must be UNOS-certified and require at least two surgeons trained in hepato-biliary surgery, as well as transplantation,” notes Kadry.

In 2008, she began the adult live donor liver transplantation program atPenn State Health Milton S. Hershey Medical Center，并实施了一种高度严格的选择性过程，用于筛选供体和接受者以及进行移植手术。“只接受了我们计划中只有大约30％的活肝捐赠者申请人。首先，独立捐助者倡导团队审查申请人的整体医疗和心理社会健康。申请人被排除在捐赠给他们的健康，心理社会情况，就业，或有证据表明捐赠的证据表明。“然后持有符合条件的申请人接受解剖肝脏研究。卡迪解释说：“捐助者必须能够提供足够的移植物体积，并且仍有大约40％的剩余功能性肝体积。只有那些患有阳性解剖学评估的那些患有肝脏活组织检查。基于活组织检查，我们排除了肝脂肪含量15％或更多的个体，我们有时会发现意想不到的先天性，代谢和传染性问题，也可能排除捐款。目标是选择肝脏捐赠的健康个体呈现最小风险。The recipients on our waiting list qualify for live donor liver transplantation but are required to have a MELD score ≤ 25. Patients with higher MELD scores are often too compromised to fully benefit from a live donor transplant and tend to develop ‘small-for-size’ syndrome, with prolonged jaundice and increased risk of infection and death,” says Kadry.

The program is unique in its adult focus; the majority of live donor programs focus on pediatric recipients. Adult live donor liver transplants are particularly challenging given the liver volume requirements and the technical complexity associated with this. The program, however, addresses a relatively larger need.

“We have been fortunate to have excellent results in our live donor liver transplant program,” explains Kadry. “Donors have fared well post-donation with a very low incidence of minor complications that have resolved without sequelae. The high level of success we’ve accomplished is not only related to our donor and recipient selection process, but also our sophisticated team. Everyone from the transplant coordinators, donor advocate group, nursing and OR staff, anesthesiologists, critical care team, histocompatibility group, hepatologists and surgeons, as well as well-defined protocols focus on identifying and following recipients most likely to benefit from live liver transplantation while minimizing donor risk.”

For more information, visitPenn State Transplant Surgery

参考

1. 美国，移植等候名单候选人，由器官;http：// optn。transplant.hrsa.gov/data., accessed June 26, 2012.
2. United States, Liver Transplants Performed; Summary January 1, 1988 March 31, 2012. at:http：// optn。transplant.hrsa.gov/latestData/rptData.asp, accessed June 26, 2012.