Maintenance of the celiac trunk with the left-sided liver allograft for in situ split-liver transplantation
Maintenance of the celiac trunk with the left-sided liver allograft for in situ split-liver transplantation
复制标题
左侧同种异体肝维持腹腔干原位劈离肝移植
作者：
M. Kılıç;P. Seu;J. Goss
背景。研究表明，原位劈离肝移植（SLT）扩大了尸体供体库，减少了受者等待时间，并降低了移植前的发病率。然而，先前描述的技术需要微血管左肝动脉吻合术。为了降低肝动脉血栓形成的发生率并加强移植团队之间的合作，在本报告中，我们描述了原位 SLT 技术的改进，该技术通过左侧同种异体肝移植来维持腹腔干。方法。 12 次原位分割肝脏采购产生了 24 个同种异体肝段移植物； 11 个右三叶、11 个左侧叶、1 个右叶和 1 个左叶。所有病例均用右侧同种异体肝移植物维持胆总管和门静脉主干。分离右肝动脉，用左侧同种异体肝保留腹腔干9例。在一例中，左肝动脉被分开，腹腔干由右侧同种异体移植物保留。 12 名捐献者中的两名拥有完全替换的左肝动脉，其起源于胃左动脉，胃左动脉在其起源处与腹腔干分开。当用左侧同种异体移植物维持腹腔干时，用髂外动脉介入移植物对右侧同种异体移植物进行动脉重建。 24 例同种异体离体肝移植中有 19 例是在我们中心移植的。其余五个同种异体肝移植物与地区肝移植中心共享。结果。在该系列中，患者和同种异体移植物的 1 年精算存活率分别为 100% 和 96%。任何接受保留腹腔干或胃左动脉的左侧劈开同种异体移植物的患者均未发生肝动脉血栓（HAT）；此外，任何右侧同种异体移植物中均未发生 HAT。一位患者移植了左侧节段但没有腹腔干，移植后立即发生了 HAT。该同种异体移植物通过早期血栓切除术和介入移植得以挽救。一名患者因门静脉血栓形成需要再次移植。所有患者均未出现肝静脉流出道梗阻。两名患者因动脉吻合口出血而需要在移植后重新探查，其中一名左侧节段同种异体移植受者出现切面胆漏，但经过非手术治疗。所有患者均存活且状况良好，包括在其他中心接受移植的 5 名患者，中位随访时间为 10 个月（范围为 1-27 个月）。结论。总之，我们的数据表明，在 SLT 中用左侧同种异体移植物维持腹腔干可提供出色的早期生存结果，并且并发症发生率低。这一技术修改消除了左肝动脉微血管吻合术的需要，并应降低小口径左肝动脉中肝动脉血栓的发生率。我们还表明，该技术允许肝移植中心之间共享，而不会影响患者或同种异体移植物的存活率。希望SLT的这一修改能够增加肝脏分割的数量，并促进移植中心之间的共享，以真正优化尸体库中可用的同种异体肝脏移植数量。
Background. It has been shown that in situ split-liver transplantation (SLT) expands the cadaveric donor pool, decreases recipient waiting time, and decreases pretransplant morbidity. However, the technique as previously described requires a microvascular left hepatic artery anastomosis. In an attempt to decrease the incidence of hepatic artery thrombosis and to increase collaboration among transplant teams, in the current report, we describe a modification of the in situ SLT technique that maintains the celiac trunk with the left-sided liver allograft. Methods. Twelve in situ split-liver procurements resulted in 24 segmental liver allografts; 11 right trisegments, 11 left lateral segments, 1 right lobe, and 1 left lobe. The common bile duct and main portal vein were maintained with the right-sided liver allograft in all cases. The right hepatic artery was divided, and the celiac trunk was maintained with the left-sided liver allograft in nine cases. In one case the left hepatic artery was divided and the celiac trunk was maintained with the right-sided allograft. Two of the 12 donors had a completely replaced left hepatic artery originating from the left gastric artery, which was divided at its origin from the celiac trunk. When the celiac trunk was maintained with the left-sided allografts, arterial reconstruction of the right-sided allograft was performed with an external iliac arterial interposition graft. Nineteen of the 24 split-liver allografts were transplanted at our center. The remaining five liver allografts were shared with regional liver transplant centers. Results. In this series, 1-year actuarial patient and allograft survival rates are 100% and 96%, respectively. Hepatic artery thrombosis (HAT) did not occur in any patient receiving a left-sided split allograft in which the celiac trunk or left gastric artery was maintained; in addition, HAT did not occur in any of the right-sided allografts. HAT did occur immediately after transplantation in the one patient who was transplanted with a left lateral segment without the celiac trunk. This allograft was salvaged by early thrombectomy and interposition grafting. One patient required retransplantation, owing to portal vein thrombosis. Hepatic venous outflow obstruction did not occur in any of the patients. Two patients required reexploration in the posttransplant period because of arterial anastomotic site bleeding, and one of the left lateral segment allograft recipients had a cut-surface bile leak, which was managed nonoperatively. All of the patients are alive and well, including the five patients who received their transplants at other centers, with a median follow-up of 10 months (range, 1–27 months). Conclusions. In summary, our data demonstrate that maintaining the celiac trunk with the left-sided allograft in SLT provides excellent early survival results with low complication rates. This technical modification obviates the need for a left hepatic artery microvascular anastomosis and should lower the incidence of hepatic artery thrombosis in the small-caliber left hepatic artery. We have also shown that this technique allows sharing among liver transplant centers without compromise in patient or allograft survival rates. It is hoped that this modification in SLT will increase the number of livers split, and will promote sharing among transplant centers to truly optimize the number of liver allografts available from the cadaveric pool.
影响因子：
6.2
作者：
Pinna, AD;Smith, CV;Fung, JJ
通讯作者：
Fung, JJ