Pure Laparoscopic Living Donor Left Lateral Sectionectomy in Pediatric Transplantation: A Propensity Score Analysis on 220 Consecutive Patients
Pure Laparoscopic Living Donor Left Lateral Sectionectomy in Pediatric Transplantation: A Propensity Score Analysis on 220 Consecutive Patients
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DOI：
10.1002/lt.25043
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发表时间：
2018-08-01
影响因子：
4.6
通讯作者：
Troisi, Roberto I.
中科院分区：
文献类型：
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作者：
Broering, Dieter C.;Elsheikh, Yasser;Troisi, Roberto I.
左外侧切除供肝切除术是一种完善的替代死亡的供体儿童肝移植。然而，很少有可用的腹腔镜入路（腹腔镜左外侧切除术[L-LLS]）。为了评估儿童活体肝移植的安全性、监护下的可重复性和结果，在一个大容量的儿科移植中心，在相对较短的时间内，使用倾向评分匹配（PSM）来评估开放式左外侧切除术（O-LLS）与L-LLS的比较单中心系列。一项回顾性、观察性、单中心、PSM研究对2011年1月至2017年4月期间连续220例活体供肝切除术患者进行了研究。PSM考虑的变量如下：手术年份、受者年龄、移植指征、受者体重、供者性别、供者年龄和供者体重指数。匹配后，拟合72个o - lls与72个l - lls进行比较。L-LLSs的手术时间和热缺血时间明显更长，而出血量和总供者并发症发生率明显较低。术后第1天和第4天，L-LLS组疼痛评分明显低于对照组（P值分别为0.015和0.003）。L-LLS患者住院时间显著缩短（4.6天比4.1天；P = 0.014）。总供者胆道并发症0 - lls为9例（12.5%），L-LLS为1例（1.4%）（P = 0.022）。无移植物丢失的腹腔镜组3例（4.2%）患儿发生血管并发症。O-LLS组1、3、5年总生存率分别为98.5%、90.9%、90.9%，L-LLS组94.3%、92.7%、86.8% （P = 0.28）。总之，L-LLS用于供肝切除术是一种安全且可重复的技术，相对于具有相似受体结果的传统方法，可获得更好的供肝围手术期结果。
Left lateral sectionectomy for donor hepatectomy is a well-established alternative to deceased donor pediatric liver transplantation. However, very little is available on the laparoscopic approach (laparoscopic left lateral sectionectomy [L-LLS]). With the aim to assess safety, reproducibility under proctorship, and outcomes following living donor liver transplantation in children, a comparative single-center series using propensity score matching (PSM) to evaluate open left lateral sectionectomy (O-LLS) versus L-LLS was carried out in a relatively short time period in a high-volume pediatric transplant center. A retrospective, observational, single-center, PSM study was conducted on 220 consecutive living donor hepatectomies from January 2011 to April 2017. The variables considered for PSM were as follows: year of operation, recipient age, indication for transplant, recipient weight, donor sex, donor age, and donor body mass index. After matching, 72 O-LLSs were fit to be compared with 72 L-LLSs. Operative time and warm ischemia time were significantly longer in L-LLSs, whereas blood loss and overall donor complication rates were significantly lower. Postoperative day 1 and 4 pain scores were significantly less in the L-LLS group (P = 0.015 and 0.003, respectively). The length of hospital stay was significantly shorter in L-LLS (4.6 versus 4.1 days; P = 0.014). Overall donor biliary complications were 9 (12.5%) and 1 (1.4%) for O-LLS and L-LLS (P = 0.022), respectively. Vascular complications occurred in 3 (4.2%) children without graft loss in the laparoscopic group. The 1-, 3-, and 5-year overall patient survival rates were 98.5%, 90.9%, and 90.9% in the O-LLS group and in the L-LLS group 94.3%, 92.7%, and 86.8% (P = 0.28). In conclusion, L-LLS for donor hepatectomy is a safe and reproducible technique yielding better donor perioperative outcomes with respect to the conventional approach with similar recipient outcomes.