Living-Donor Liver Transplantation With Hyperreduced Left Lateral Segment Grafts: A Single-Center Experience
Living-Donor Liver Transplantation With Hyperreduced Left Lateral Segment Grafts: A Single-Center Experience
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DOI：
10.1097/tp.0b013e31827a93b4
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发表时间：
2013-03-15
期刊：
影响因子：
6.2
通讯作者：
Kasahara, Mureo
中科院分区：
文献类型：
--
作者：
Kanazawa, Hiroyuki;Sakamoto, Seisuke;Kasahara, Mureo
背景在接受左外侧段（LLS）移植的小婴儿肝移植的背景下，遇到了与所谓的“大尺寸”移植物形式的移植物尺寸不匹配相关的问题。为了解决这些问题，研究了进一步减小LLS移植物尺寸以形成超还原LLS（HRLLS）移植物的可行性。在2005年11月至2011年12月期间在我们研究所进行的175例儿童活体肝移植中，31例使用HRLLS移植物进行。回顾性分析患者的病历资料。移植物与受体体重比成功从5.2%+/- 2.0%降至2.9%+/-0.5%。门静脉血栓形成1例，胆管狭窄2例。无肝动脉血栓形成。移植物和患者2年生存率为87%。当根据原始疾病分类的结果得到验证时，与胆汁淤积或代谢性疾病患者相比，暴发性肝功能衰竭（FHF）患者体重较轻，腹腔较小。FHF患者经常需要皮肤或部分皮肤闭合，以避免移植物压缩。因此，受者腹腔的前后径不足以容纳移植物的厚度，尤其是FHF患者。总之，使用HRLLS移植物的活体肝移植为治疗较小婴儿提供了一种安全且有用的选择。
Background. In the setting of liver transplantation in small infants who receive left lateral segment (LLS) grafts, problems are encountered related to graft-size mismatching in the form of so-called "large-for-size" grafts. To address these problems, the feasibility of further reducing the size of LLS grafts to form hyperreduced LLS (HRLLS) grafts was investigated.Methods. Of the 175 pediatric living-donor liver transplantations performed between November 2005 and December 2011 at our institute, 31 cases were performed using HRLLS grafts. The medical records were reviewed and data were collected retrospectively.Results. The graft-to-recipient body weight ratio was successfully reduced from 5.2%+/- 2.0% to 2.9%+/- 0.5%. Portal vein thrombosis was observed in one case, and biliary stenosis was seen in two cases. No hepatic artery thrombosis was encountered. The graft and patient 2-year survival rate was 87%. When the results categorized according to the original disease were verified, patients with fulminant hepatic failure (FHF) weighed less and had smaller abdominal cavities compared with patients with cholestatic or metabolic disease. Patients with FHF frequently required skin or partial skin closure to avoid graft compression. For this reason, the anteroposterior diameters in the recipients' abdominal cavities were not adequately large to accommodate the graft thickness, especially in patients with FHF.Conclusions. In conclusion, living-donor liver transplantation using HRLLS grafts offers a safe and useful option for treating smaller infants.