Linkslaterale Leberlebendspende – Erfahrungen aus Essen

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.

Schlüsselwörter

Lebertransplantation - Leberlebendspende - Transplantationschirurgie - postoperative Komplikation - Patientensicherheit

Key words

liver transplantation - living liver donation - transplantation surgery - postoperative complications - patient safety

• Literatur

• Research Group SPLIT. Studies of Pediatric Liver Transplantation (SPLIT): Year 2000 Outcomes. Transplantation 2001; 72: 463-476
• Vagefi PA, Parekh J, Ascher NL. et al. Outcomes with split liver transplantation in 106 recipients. Arch Surg 2011; 146: 1052-1059
• 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
• 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
• 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
• Broelsch CE, Whitington PF, Emond JC. et al. Liver transplantation in children. Ann Surg 1991; 214: 428-437
• Dindo D, Demartines N, Clavien PA. Classification of surgical complications. Ann Surg 2004; 240: 205-213
• 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
• Im Internet. www.bmg.bund.de § 3 + §4 TPG Stand Oktober 2012.
• Im Internet. www.bmg.bund.de § 8 Abs. 1 TPG Stand Oktober 2012.
• Erim Y, Beckmann M, Gerken G. et al. Psychosomatic aspects of living donor liver transplantation. Chirurg 2010; 81: 820-825
• 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
• 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
• 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
• Belghiti J, Kabbej M, Sauvanet A. et al. Drainage after elective hepatic resection. Ann Surg 1993; 218: 748-753
• 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
• Umeshita K, Fujiwara K, Kiyosawa K. et al. Operative morbidity of living liver donors in Japan. Lancet 2003; 362: 687-690
• Renz JF, Roberts JP. Long-term complications of living donor liver transplantation. Liver Transpl 2000; 6: S73-S76
• 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
• Grewal HP, Thistlewaite JR, Loss GE. et al. Complications in 100 living-liver donors. Ann Surg 1998; 228: 214-219
• Heise M, Jandt K, Rauchfuss F. et al. Managment of complications after liver resection. Zentralbl Chir 2010; 135: 112-120
• Soejima Y, Shirabe K, Taketomi A. et al. Left lobe living donor liver transplantation in adults. Am J Transplant 2012; 12: 1877-1885
• 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
• 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
• Ghobrial RM, Freise CE, Trotter JF. et al. Donor morbidity after living donation for liver transplantation. Gastroenterology 2008; 135: 468-476
• 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
• Ringe B, Strong RW. The dilemma of living liver donor death: to report or not to report?. Transplantation 2008; 85: 790-793
• Lee SG. Asian contribution to living donor liver transplantation. J Gastroenterol Hepatol 2006; 21: 572-574
• 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
• 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