辅助肝移植： 提升供肝利用率的机遇与挑战

艾孜曼提·艾山江; 钟锴; 阿力木·土拉宏; 郭强; 张瑞青; 吐尔干艾力·阿吉

doi:10.12449/JCH260633

辅助肝移植：提升供肝利用率的机遇与挑战

DOI: 10.12449/JCH260633

1.
新疆医科大学第一附属医院消化血管外科中心肝胆包虫病外科，乌鲁木齐 830013
2.
新疆医科大学省部共建中亚高发病成因与防治国家重点实验室，乌鲁木齐 830013

基金项目:

“天山英才”培养计划科技创新领军人才项目 (2022TSYCLJ0034)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：艾孜曼提·艾山江负责查找文献，撰写和修改论文；钟锴、张瑞青负责论文修改；阿力木·土拉宏负责查找文献及图片绘制；郭强负责论文修改及指导文章撰写；吐尔干艾力·阿吉负责拟定写作思路，指导文章撰写，修改论文并最后定稿。

详细信息

通信作者:
吐尔干艾力·阿吉， tuergan78@sina.com （ORCID： 0000-0001-6737-8874）

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出版历程
- 收稿日期: 2025-12-04
- 录用日期: 2026-01-16
- 出版日期: 2026-06-25

Auxiliary liver transplantation： Opportunities and challenges in improving donor liver utilization rate

Aishanjiang AIZIMANTI¹,
Kai ZHONG^{1, 2},
Tulahong ALIMU^{1, 2},
Qiang GUO^{1, 2},
Ruiqing ZHANG^{1, 2},
Aji TUERGANAILI^{1, 2
, ,
,}

1.
Department of Hepatobiliary and Echinococcosis Surgery，Digestive & Vascular Surgery Center，The First Affiliated Hospital of Xinjiang Medical University，Urumqi 830013，China
2.
State Key Laboratory of Pathogenesis，Prevention and Treatment of High Incidence Diseases in Central Asia Co-founded by Province and Ministry，Xinjiang Medical University，Urumqi 830013，China

Research funding:

“Tianshan Talents” Training Plan Leading Talents in Scientific and Technological Innovation (2022TSYCLJ0034)

摘要

摘要: 肝移植是终末期肝病的标准疗法，但长期受限于供肝短缺。临床实践中，三类供肝（多米诺供肝、小尺寸移植肝和脂肪变性供肝）因代谢缺陷、体积不足和质量欠佳等问题面临使用限制。本综述系统梳理了多米诺供肝、小尺寸移植肝和脂肪变性供肝的定义、应用现状及使用瓶颈，重点阐述辅助肝移植（保留受体部分或全部自体肝脏、叠加供肝功能支持的特殊术式）在规避小肝综合征、弥补代谢缺陷和拓展边缘肝应用等方面的独特价值与临床实践进展，旨在为优化终末期肝病肝移植策略、提升供肝利用率提供针对性的临床实践参考。
- 肝移植 /
- 多米诺肝移植 /
- 辅助肝移植 /
- 边缘肝
Abstract: Liver transplantation is the standard treatment for end-stage liver disease， but it has long been limited by the shortage of donor livers. In clinical practice， three types of donor liver （domino donor livers， small-for-size grafts， and steatotic donor livers） are limited due to issues such as metabolic defects， insufficient volume， and poor quality. This article systematically reviews the definition， clinical application， and bottlenecks of the above three types of donor livers and elaborates on the unique value and clinical practice advances of auxiliary liver transplantation （a special surgical procedure that retains part or all of the recipient’s own liver and superimposes donor liver function support） in avoiding small-for-size syndrome， compensating for metabolic defects， and expanding the application of marginal livers， in order to provide a targeted clinical practice reference for optimizing liver transplantation strategies for end-stage liver disease and improving donor liver utilization rate.
- Liver Transplantation /
- Domino Liver Transplantation /
- Auxiliary Liver Transplantation /
- Marginal Liver

HTML全文

注： a，下腔静脉；b，腹主动脉；c，肝静脉；d，肝动脉；e，门静脉；f，胆管；g，肠管；h，肝脏；i，髂动脉；j，髂静脉；k，膀胱。

图 1 辅助肝移植示意图

Figure 1. Schematic diagram auxiliary liver transplantation

下载: 全尺寸图片幻灯片

图 2 多米诺供肝交叉辅助式肝移植示意图

Figure 2. Schematic diagram cross-auxiliary domino liver transplantation

下载: 全尺寸图片幻灯片

表 1 辅助肝移植与传统肝移植对比

Table 1. Comparison of adjuvant liver transplantation with conventional liver transplantation

项目	辅助肝移植	传统肝移植
适应证	急性/亚急性肝衰竭、高脱落风险者、NCIMLD患者、接受小体积供肝者	终末期肝硬化、急/慢加急性肝衰竭、米兰标准的恶性肿瘤、自身免疫性/代谢性肝病
体积要求	可采用GRWR<0.8%的小体积活体供肝、GRWR≤1.0% 的脑/心死亡劈裂供肝	GRWR>0.8%或GV/SLV>40%
脂肪变性	可耐受大泡性脂肪变性>30%	大泡性脂肪变性<30%
供肝类型	多米诺供肝、小体积劈裂式/活体供肝、边缘供肝/弃肝	脑/心死亡供肝、足量体积劈裂/活体供肝、部分多米诺供肝
优势	保留自体肝，肝功能叠加；供肝要求低，利用率高；可停用免疫抑制剂	肝脏置换彻底，长期疗效稳定；技术成熟，术程标准化；普及度高，为肝移植主流术式
不足	技术复杂、仅少数中心开展；依赖个体化方案，无统一标准；长期预后存残肝相关风险；部分需Ⅱ期切除残肝；并发症及远期预后证据不足	供肝短缺；供肝要求严、利用率低；终生服用免疫抑制剂；受体等待期间脱落/死亡风险高
注：NCIMLD，非硬化性遗传代谢性肝脏疾病；GRWR，移植物与受体重量比；GV/SLV，移植肝体积与标准肝体积比。

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