Dondero F, Taillé C, Mal H, Sommacale D, Sauvanet A, Farges O, Francoz C, Durand F, Delefosse D, Denninger MH, Vilgrain V, Marrash-Chahla R, Fournier M, Belghiti J.
肝胆病理科，Beaujon医院，克里奇，法国

背景：肝移植供体出现发病率和/或死亡率的风险是活体肝移植中最受关注的问题之一。目前已经有关于供体移植术后发生呼吸道并发症的报道，但是该病的发生率似乎被低估了。我们设计了一项前瞻性研究，对112例连续捐赠者术后肺部并发症的发病率和性质进行了评估。

方法：我们审查了本中心1998年至2003年期间112例活体肝移植捐赠者的病案，并同时回顾了所有呼吸道并发症的案例。此外从2000年起，我们在第7天还前瞻性的对所有患者进行了胸部CT血管造影。

结果：本中心总共进行了112例成人-成人或成人-小儿活体肝移植的肝切除术，无术后死亡记录。11例（9.8%）捐赠者（包括所有进行肝右叶切除的捐赠者）出现了14种重大呼吸道并发症，包括不严重的肺动脉栓塞（n=7）、右胸腔积脓（n=3）和细菌性肺炎（n=3）。轻微的呼吸道并发症（占捐赠者的7.1%）包括医源性气胸（n=3）和需要通过胸腔穿刺治疗的胸腔积液（n=5）。１０例（８.９％）捐赠者出现了腹部并发症（主要是胆漏），这１０例捐赠者大部分都没有发生肺部并发症。

结论：在我们的研究中，活体肝移植捐赠者频繁发生肺部并发症，主要出现在肝右叶切除术之后。肺动脉栓塞的高发病率提示我们应该把重点放在早期诊断和预防上。

Respiratory complications: a major concern after right hepatectomy in living liver donors
Dondero F, Taillé C, Mal H, Sommacale D, Sauvanet A, Farges O, Francoz C, Durand F, Delefosse D, Denninger MH, Vilgrain V, Marrash-Chahla R, Fournier M, Belghiti J.
Département de Pathologie Hépato-Biliaire, Hpital Beaujon, Clichy, France.

BACKGROUND: One of the main concerns after living donor liver transplantation is the risk of morbidity and/or mortality that it imposes on the donors. Respiratory postoperative complications in living liver donors have already been reported but their frequency seems to be underestimated. We designed a prospective study to evaluate the rate and the nature of postoperative pulmonary complications in 112 consecutive donors.

METHODS: The medical records of the 112 living liver donors operated on at our center from 1998 to 2003 were reviewed and all the cases of respiratory complications were retrieved. Moreover, since 2000, all patients had a computed tomography angiography of the thorax at day 7 on a prospective basis.

RESULTS: In all, 112 hepatectomies (44 right and 68 left) for adult-to-adult or adult-to-child liver donation were performed in our center. No postoperative mortality was recorded. Fourteen major respiratory complications developed in of 11 of 112 donors (9.8%), in all cases after right hepatectomy, and included nonsevere pulmonary embolism (n=7), right pleural empyema (n=3), and bacterial pneumonia (n=3). Minor respiratory complications (7.1% of the donors) included iatrogenic pneumothorax (n=3) and pleural effusion requiring thoracocentesis (n=5). Abdominal complications (mainly biliary leak) developed in 10 donors (8.9%), who in the vast majority remained free of pulmonary complications.

CONCLUSIONS: In our series, pulmonary complications are frequent in living liver donors. These complications are mainly observed after right hepatectomy. The particular prevalence of pulmonary embolism should lead to focus on its early diagnosis and prevention.

Transplantation. 2006 Jan 27;81(2):181-6.
PMID: 16436960 [PubMed - indexed for MEDLIN

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