Increasing the recipient benefit/donor risk ratio by lowering the graft size requirement for living donor liver transplantation
Increasing the recipient benefit/donor risk ratio by lowering the graft size requirement for living donor liver transplantation
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DOI：
10.1002/lt.23433
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发表时间：
2012-09
影响因子：
4.6
通讯作者：
S. Chan;S. Fan;K. Chok;W. Sharr;W. Dai;James Fung;Kwok Yin Chan;D. Balsarkar;C. Lo
中科院分区：
文献类型：
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作者：
S. Chan;S. Fan;K. Chok;W. Sharr;W. Dai;James Fung;Kwok Yin Chan;D. Balsarkar;C. Lo
在活体供体肝移植(LDLT)中，右肝移植比左肝移植大，因此受体存活率更高。然而，与供体左肝切除相比，供体右肝切除具有更高的供体风险。我们通过以5%的增量降低移植物重量(GW)/标准肝体积(SLV)比率来评估左肝活体肝移植(LLDLT)的适用性的扩展。连续的LDLT病例被纳入这项研究。计算机断层扫描的结果提供了移植物体积的测量结果，GW是由移植物体积得出的，换算系数为1.19mL/g。我们试图估计如果GW/SLV要求降低到40%、35%、30%或25%，LLDLT还可以再进行多少次。总共有361对连续的供受者对接受了LDLT。右肝活体供肝移植(RLDLT)占95%。受者多为男性(74.2%)，供者多为女性(60.4%)。GW/SLV比率的中位数为46%(RLDLT组为47%，LLDLT组为37%，P<；0.001)。218名女性捐赠者中有两人捐赠了左肝，93名女性受赠者中有12人接受了左肝捐赠。供者为女性，受者为男性的173例中，有147例(85%)GW/SLV未达30%。如果采用较低的GW/SLV要求，LLDLT的实施频率可能超过5%。当GW/SLV比例分别为≥40%、≥35%、≥30%和≥25%时，LLDLT病例的比例将分别从5%上升到5.8%、12.5%、29.1%和62.3%。当GW/SLV要求每减少5%时，LLDLT的执行频率可能会增加大约两倍。总之，降低移植物大小要求可以提高LLDLT的适用性，从而降低供体风险。《肝脏运输》，2012年。©2012 AASLD。
In living donor liver transplantation (LDLT), a right liver graft is larger than a left liver graft and hence leads to better recipient survival. However, in comparison with donor left hepatectomy, donor right hepatectomy carries a higher donor risk. We estimated the expansion of the applicability of left liver living donor liver transplantation (LLDLT) by lowering the graft weight (GW)/standard liver volume (SLV) ratio in increments of 5%. Consecutive LDLT cases were included in this study. The results of computed tomography volumetry provided the graft volume measurements, and the GW was derived from the graft volume with the conversion factor of 1.19 mL/g. We tried to estimate how many more times LLDLT would have been feasible if the GW/SLV requirement had been lowered to 40%, 35%, 30%, or 25%. In all, 361 consecutive donor‐recipient pairs underwent LDLT. Right liver living donor liver transplantation (RLDLT) accounted for 95% of the LDLT cases. Most recipients were male (74.2%), and most donors were female (60.4%). The median GW/SLV ratio was 46% (47% for RLDLT and 37% for LLDLT, P < 0.001). Two of the 218 female donors donated the left liver, and 12 of the 93 female recipients received a left liver. In 147 of the 173 cases (85%) when the donor was female and the recipient was male, the GW/SLV ratio did not reach 30%. LLDLT could have been performed more often than 5% of the time if a lower GW/SLV requirement had been adopted. With GW/SLV ratios ≥ 40%, ≥ 35%, ≥ 30%, and ≥ 25%, the proportion of LLDLT cases would have risen from 5% to 5.8%, 12.5%, 29.1%, and 62.3%, respectively. LLDLT could have been performed approximately twice as often with every 5% reduction of the GW/SLV requirement. In conclusion, lowering the graft size requirement could improve the applicability of LLDLT and hence reduce donor risk. Liver Transpl, 2012. © 2012 AASLD.