Is graft size a major risk factor in living-donor adult liver transplantation?
Is graft size a major risk factor in living-donor adult liver transplantation?
复制标题
移植物大小是活体成人肝移植的主要危险因素吗？
作者：
M. Shimada;H. Ijichi;Y. Yonemura;N. Harada;S. Shiotani;M. Ninomiya;T. Yoshizumi;Y. Soejima;T. Suehiro;Y. Maehara
移植物大小是已知的活体供者成人肝移植（LDALT）的主要风险因素。本研究的目的是重新评估移植物大小是否是LDALT的关键因素。分析了排除辅助移植和ABO血型不合移植的75例LDALT。根据移植肝体积（GV）和标准肝体积（SLV）分为小肝组（GV/SLV <40%）和非小肝组（GV/SLV ≥40%）。比较两组的围手术期临床资料，包括移植物存活率和术后并发症。这些参数也进行了比较的条件下，移植受体。两组间移植物存活率无差异。术后并发症的发生率无差异，如顽固性腹水和持续性高胆红素血症。即使在Child-Pugh分级为C级的患者中，两组之间的移植物存活率也没有差异。与移植物丢失相关的风险因素是由于慢性肝病导致的术前紧急状态，术前高胆红素血症超过10 mg/dl，以及供体和受体之间ABO血型不相同但相容的组合。移植物大小并不总是被认为是LDALT的主要风险因素，尽管本研究中的患者数量较少。因此，左肝叶移植，即使是成人受体的“小尺寸”移植，仍然是LDALT的可行选择。
Graft size is known to be a major risk factor in living donor adult liver transplantation (LDALT). The aim of this study is to reassess whether graft size is a critical factor in LDALT or not. A series of 75 LDALTs excluding auxiliary transplantation and ABO blood-type incompatible transplantation were analyzed. The patients were divided into two groups, according to graft volume (GV) and standard liver volume (SLV): group 1 (small-size group) (GV/SLV: <40%), and group 2 (non-small-size group) (≥40%). Perioperative clinical data were compared between the two groups, including graft survival and postoperative complications. These parameters were also compared under the conditions of cirrhotic recipients. No difference in graft survival was found between the two groups. No difference was found in incidence of postoperative complications, such as intractable ascites and persistent hyperbilirubinemia. Even in cirrhotic patients with Child–Pugh’s class C, there was no difference in graft survival between the two groups. Risk factors related to graft loss were a preoperative urgent status due to chronic liver disease, pre-operative hyperbilirubinemia of over 10 mg/dl, and ABO blood type of not identical but compatible combination between donor and recipient. Graft size is not always considered to be a major risk factor in LDALT, although the number of patients was small in this study. Therefore, a left-lobe graft, even a “small-for-size” graft for adult recipients, remains a feasible option in LDALT.