Impact of graft thickness reduction of left lateral segment on outcomes following pediatric living donor liver transplantation
Impact of graft thickness reduction of left lateral segment on outcomes following pediatric living donor liver transplantation
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DOI：
10.1111/ajt.14875
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发表时间：
2018-09-01
影响因子：
8.8
通讯作者：
Kasahara, Mureo
中科院分区：
文献类型：
--
作者：
Kitajima, Toshihiro;Sakamoto, Seisuke;Kasahara, Mureo
在儿科活体供肝移植(LDLT)中，减少移植物厚度是防止大体积移植物问题的关键。然而，使用减厚左外侧节段(LLS)移植物的LDLT的长期结果尚不清楚。在2005年至2017年间使用减薄LLS移植物进行LDLT的89名患者中，比较了非解剖复位LLS(NAR-LLS)移植物组和减厚LLS移植物组的短期和长期结果。减厚LLS移植组在受体手术中估计的出血量较少，腹部皮肤闭合较少。NAR-LLS组术后门静脉血流量明显减少，ICU住院时间缩短，术后并发症减少，尤其是菌血症。减厚LLS移植后1年和3年的存活率分别为95.2%和92.4%，明显优于NAR-LLS移植。多因素分析显示，暴发性肝功能衰竭、LDLT前肝静脉血流和NAR-LLS移植物与移植物存活率低有关。总之，与NAR-LLS相比，使用减厚LLS的LDLT是一种安全可行的选择，具有更好的短期和长期效果。在接受减左外侧段活体供肝移植的儿童患者中，与使用非解剖结构的减薄移植物相比，减薄的移植物厚度与更好的患者和移植物存活率密切相关。
Reducing graft thickness is essential to prevent large-for-size graft problems in pediatric living donor liver transplantation (LDLT). However, long-term outcomes of LDLT using reduced-thickness left lateral segment (LLS) grafts are unclear. In 89 patients who underwent LDLT using reduced LLS grafts between 2005 and 2017, short-term and long-term outcomes were compared between a nonanatomically reduced LLS (NAR-LLS) graft group and a reduced-thickness LLS graft group. Estimated blood loss was lower and abdominal skin closure was less needed in the recipient operation in the reduced-thickness LLS graft group. Postoperatively, portal vein (PV) flow was significantly decreased in the NAR-LLS graft group, and there was shorter intensive care unit (ICU) stay and fewer postoperative complications, especially bacteremia, in the reduced-thickness LLS graft group. Graft survival at 1 and 3years after LDLT using reduced-thickness LLS grafts was 95.2% and 92.4%, respectively, which was significantly better than for NAR-LLS grafts. Multivariate analysis revealed that fulminant liver failure, hepatofugal PV flow before LDLT, and NAR-LLS graft were associated with poor graft survival. In conclusion, LDLT using reduced-thickness LLS grafts is a safe and feasible option with better short- and long-term outcomes in comparison with NAR-LLS grafts.In pediatric patients undergoing living donor liver transplantation with a reduced left lateral segment graft, reducing the graft thickness is strongly associated with better patient and graft survival in comparison to liver transplantation using a nonanatomically reduced graft.