Outcome analysis in adult-to-adult living donor liver transplantation using the left lobe
Outcome analysis in adult-to-adult living donor liver transplantation using the left lobe
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DOI：
10.1053/jlts.2003.50114
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发表时间：
2003-06-01
影响因子：
4.6
通讯作者：
Maehara, Y
中科院分区：
文献类型：
--
作者：
Soejima, Y;Shimada, M;Maehara, Y
移植物尺寸问题仍然是活体肝移植（LDLT）扩大到成年人群的最大限制因素。迄今为止，使用左肺叶并特别参考移植物尺寸的成人对成人 LDLT 的结果尚未得到充分评估。在这项研究中，我们使用左肺叶评估了成人至成人 LDLT 的结果，并分析了使用小型移植物对结果的影响。该研究纳入了 36 名接受左叶 (n = 14) 或左叶加尾状叶 (n = 22) 接受成人到成人 LDLT 的受者。研究的变量包括术前和手术数据、患者和移植物存活率、并发症以及移植物丢失的原因。此外，还研究了小尺寸综合征的发生率及其对移植物存活的影响。平均移植物体积 (GV) 为 420 +/- 85 g（范围，260 至 620 g），占受者标准肝脏体积 (SLV) 的 38.2% +/- 8.1%（范围，22.8% 至 53.8%）。患者和移植物的总体 1 年存活率分别为 85.7% 和 82.9%。七个移植物丢失。 16 名肝硬化患者中有 7 名 (43.8%) 发生小尺寸综合征，而 20 名无肝硬化患者中只有 1 名 (5.0%) (P =.005)。发生小尺寸综合征的受者的移植物存活率低于未发生小尺寸综合征的受者 (P =.07)。总之，成人对成人的 LDLT 被认为是可行的，不会影响患者或移植物的存活。小尺寸综合征在肝硬化患者中更常见。对于没有肝硬化的患者，成人至成人 LDLT 的最小 GV 应比接受者的 SLV 低 30%，而对于肝硬化患者则需要低 45%。
Graft size problems remain the greatest limiting factor for expansion of living donor liver transplantation (LDLT) to the adult population. The result of adult-to-adult LDLT using the left lobe with special reference to graft size has not been fully evaluated to date. In this study, we evaluated the outcome of adult-to-adult LDLT using the left lobe and also analyze the impact of using small-for-size grafts on outcome. Thirty-six recipients who underwent adult-to-adult LDLT using the left lobe (n = 14) or left lobe plus caudate lobe (n = 22) were included in the study. Variables including preoperative and operative data, patient and graft survival, complications, and causes of graft loss were studied. Furthermore, the incidence of small-for-size syndrome and its impact on graft survival were studied. Mean graft volume (GV) was 420 +/- 85 g (range, 260 to 620 g), which resulted in 38.2% +/- 8.1% (range, 22.8% to 53.8%) of the recipient standard liver volume (SLV). Overall 1-year patient and graft survival rates were 85.7% and 82.9%, respectively. Seven grafts were lost. Small-for-size syndrome occurred in 7 of 16 patients (43.8%) with cirrhosis and only 1 of 20 patients (5.0%) without cirrhosis (P =.005). Recipients who developed small-for-size syndrome had inferior graft survival to those who did not (P =.07). In conclusion, adult-to-adult LDLTs were found to be feasible without affecting patient or graft survival. Small-for-size syndrome developed more frequently in patients with cirrhosis. Minimum GV in adult-to-adult LDLT should be 30% less than the recipient's SLV in patients without cirrhosis, whereas 45% less was required in patients with cirrhosis.