Un articolo comparso su una autorevole rivista scientifica nel febbraio 2003.
Riguarda i trapianti di fegato da donatore vivente adulto a ricevente adulto. Si tratta ovviamente di un trapianto del lobo destro del fegato.
L'argomento č di viva attualitā e riguarda i rischi ed i vantaggi ottenibili da questo tipo di trapianti.
Si tratta di uno studio statunitense molto ampio e riguarda 449 trapianti di fegato da vivente, da adulto ad adulto.
I rischi per il donatore esistono, come specificato nell'articolo, con una mortalitā dello 0,2%.
Le complicanze avvengono soprattutto nei Centri con una minore esperienza.
survey of liver transplantation from living adult donors in the United
N Engl J Med 2003 Feb 27;348(9):818-25
Brown RS Jr, Russo MW, Lai M, Shiffman ML, Richardson MC, Everhart JE, Hoofnagle JH.
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA. firstname.lastname@example.org
BACKGROUND: The transplantation of the right lobe of a liver from a living adult donor into an adult recipient has been performed increasingly frequently in the United States. Although the use of grafts from living donors is standard practice in transplantation in children, their use in adults remains controversial. METHODS: To study the use of liver transplantation from a living donor, we sent a 24-item questionnaire to all liver-transplantation programs in the United States. Data on indications, evaluation, and outcomes were analyzed with the use of univariate and multivariate methods. Data on recent transplantations were gathered from the Scientific Registry of Transplant Recipients and directly from the transplantation programs. RESULTS: Questionnaires were returned by 84 of the 122 programs (69 percent) describing the results of 449 adult-to-adult transplantations of partial livers from living donors that were performed in 42 centers. Fourteen centers had performed more than 10 such transplantations each and together accounted for 80 percent of such transplantations. Centers that performed such transplantations also performed more transplantations of livers from cadaveric donors and more transplantations from living donors in children than centers that did not perform the adult-to-adult procedure (P=0.002 and P=0.001, respectively). A total of 45 percent of potential donors who were evaluated eventually donated a lobe of their liver; 99 percent of these donors were genetically or emotionally related to the recipient. Complications in the donor were more frequent in the centers performing the fewest transplantations from living donors in adults and included biliary complications requiring intervention (in 6.0 percent), reoperation (in 4.5 percent), and death (in one donor [0.2 percent]). Among the recipients, 1.6 percent did not meet criteria for receipt of a cadaveric transplant; cancer, retransplantation, and acute liver failure were uncommon indications for transplantation from a living donor. Biliary complications occurred in 22.0 percent of recipients, and vascular complications occurred in 9.8 percent. CONCLUSIONS: Adult-to-adult liver transplantation from a living donor is increasingly performed in the United States but is concentrated in a few large-volume centers. Mortality among donors is low, but complications in the donor are relatively common. Copyright 2003 Massachusetts Medical Society