Left lobe graft poses a potential risk of hepatic venous outflow obstruction in adult living donor liver transplantation.
Left lobe graft poses a potential risk of hepatic venous outflow obstruction in adult living donor liver transplantation.
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左叶移植物在成人活体肝移植中存在肝静脉流出阻塞的潜在风险。
DOI：
10.1002/lt.24399
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Uemoto S.
中科院分区：
文献类型：
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作者：
Kitajima T;Kaido T;Iida T;Yagi S;Fujimoto Y;Ogawa K;Mori A;Okajima H;Imamine R;Shibata T;Uemoto S.
肝静脉流出道梗阻（HVOO）是活体肝移植术后的严重并发症。本研究旨在评估成人HVOO的发病率和HVOO的危险因素。从2005年至2015年，入组了430例成人LDLT患者（右叶[RL]移植，270例患者;左叶[LL]移植，160例患者），并分为无HVOO（n = 413）和HVOO（n = 17）组。比较患者人口统计学和手术数据，并分析HVOO的风险因素。此外，经皮介入治疗HVOO的长期结果进行了评估。17例（4.0%）患者发生HVOO。接受LL移植的患者中HVOO的发生率显著高于接受RL移植的患者（8.1% vs 1.5%;P =0.001）。HVOO组的体重和肝静脉吻合口口径明显低于无HVOO组（P= 0.02和P = 0.008）。多变量分析显示，仅LL移植物是HVOO的独立风险因素（OR，4.782; 95% CI，1.387 - 16.488;P= 0.01）。在17例HVOO患者中，7例患者接受单球囊血管成形术治疗，9例复发患者接受重复干预治疗。总体而言，6例患者接受了支架置入术：1例在初次手术时，3例在第二次手术时因早期复发，2例在重复球囊血管成形术（≥3次介入）后。这6例患者均未复发。HVOO组和无HVOO组的移植物总存活率无显著差异（P= 0.99）。总之，LL移植物的使用与HVOO相关，经皮介入治疗LDLT后成人HVOO是有效的。肝移植22 785-795 2016 AASLD。
Hepatic venous outflow obstruction (HVOO) is a critical complication after living donor liver transplantation (LDLT). This study aimed to evaluate the incidence of HVOO and the risk factors for HVOO in adults. From 2005 to 2015, 430 adult LDLT patients (right lobe [RL] graft, 270 patients; left lobe [LL] graft, 160 patients) were enrolled and divided into no HVOO (n = 413) and HVOO (n = 17) groups. Patient demographics and surgical data were compared, and risk factors for HVOO were analyzed. Furthermore, the longterm outcomes of percutaneous interventions as treatment for HVOO were assessed. HVOO occurred in 17 (4.0%) patients. The incidence of HVOO in patients receiving a LL graft was significantly higher than in those receiving a RL graft (8.1% versus 1.5%;P =0.001). The body weight and caliber of hepatic vein anastomosis in the HVOO group were significantly lower compared with the no HVOO group (P= 0.02 andP= 0.008, respectively). Multivariate analysis revealed that only LL graft was an independent risk factor for HVOO (OR, 4.782; 95% CI, 1.387‐16.488;P= 0.01). Among 17 patients with HVOO, 7 patients were treated with single balloon angioplasty, and 9 patients who developed recurrence were treated with repeated interventions. Overall, 6 patients underwent stent placement: 1 at the initial procedure, 3 at the second procedure for early recurrence, and 2 following repeated balloon angioplasty (≥3 interventions). These 6 patients experienced no recurrence. Overall graft survival was not significantly different between the HVOO and no HVOO groups (P= 0.99). In conclusion, the use of a LL graft was associated with HVOO, and percutaneous interventions were effective for treating adult HVOO after LDLT.Liver Transplantation 22 785–795 2016 AASLD.