Living donor liver transplantation with reduced monosegments for neonates and small infants
Living donor liver transplantation with reduced monosegments for neonates and small infants
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DOI：
10.1097/01.tp.0000263340.82489.18
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发表时间：
2007-05-27
期刊：
影响因子：
6.2
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
--
作者：
Ogawa, Kohei;Kasahara, Mureo;Uemoto, Shinji
背景。在儿童活体肝移植中，左外侧段或单节段移植用于克服成人供体和儿童受体之间的大小差异。然而，对于新生儿和极小的婴儿，即使使用这种移植物，有时也会遇到与大尺寸移植物相关的问题。减少单节段移植物，其中单节段移植物的尾部部分被切除，已经被引入来解决这个问题。在1990年6月至2004年9月间接受移植的566名儿童中，有9名患者采用了减量单节段活体肝移植（中位年龄144天，中位体重4.1 kg）。该技术用于使用左外侧节段时估计移植物与受体重量比(GRWR) >= 4.0%的婴儿。移植和患者生存率为66.7%。GRWR由7.45 +/- 2.70%降至3.39 +/- 0.89%。移植后第1天和第2天，缩小单节段移植的转氨酶水平明显高于左外侧节段移植。肝动脉血栓和门静脉血栓各1例。减少单节段活体供肝移植是新生儿和极小婴儿肝功能衰竭的可行选择。
Background. In pediatric living donor liver transplantation, left lateral segment or monosegmental graft is used to overcome size discrepancies between adult donors and pediatric recipients. For neonates and extremely small infants, however, problems related to large-for-size graft are sometimes encountered even when using such grafts. The reduced monosegmental graft, in which the caudal part of the monosegmental graft is resected, has been introduced to address this problem.Methods. Of 566 children who underwent transplant between June 1990 and September 2004, reduced monosegment living donor liver transplants were used for nine patients (median age, 144 days; median weight, 4.1 kg). This technique was used for infants with estimated graft-to-recipient weight ratio (GRWR) >= 4.0% when using the left lateral segment.Results. Graft and patient survival was 66.7%. GRWR was reduced from 7.45 +/- 2.70% to 3.39 +/- 0.89% using this modification. Transaminase levels at days 1 and 2 after transplantation were significantly higher in reduced monosegmental transplantation than in left lateral segmental transplantation. Hepatic artery thrombosis and portal vein thrombosis were observed in one case each.Conclusion. Reduced monosegmental living donor liver transplantation represents a feasible option for neonates and extremely small infants with liver failure.