Graft size, donor age, and patient status are the indicators of early graft function after living donor liver transplantation
Graft size, donor age, and patient status are the indicators of early graft function after living donor liver transplantation
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DOI：
10.1002/lt.21462
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发表时间：
2008-07-01
影响因子：
4.6
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Yoshizumi, Tomoharu;Taketomi, Akinobu;Maehara, Yoshihiko
目前还没有可靠的模型来预测活体肝移植（LDLT）后的早期移植物功能和患者存活率。本研究的目的是建立一个新的公式，预测早期移植功能和预后的锝-99 m半乳糖基-人血清白蛋白（Tc-GSA）肝显像。在LDLT后7天测定Tc-GSA的肝摄取率与Tc-GSA的清除指数（LHL/HH）的比值。22例患者的比值大于1.3，6例患者的比值小于1.3。比较两组术后第14天（POD）的移植物功能。建立了一个新的预测LHL/HH评分的公式：LHL/HH（预测评分）= 0.011 ×移植物重量（%）0.016 ×供体年龄-0.008 ×终末期肝病模型评分-0.15 ×分流（如果存在）+1.757（r（2）= 0.497，P < 0.01）。将该预测的LHL/HH比值与110例LDLT患者术后第14天的移植物功能进行比较。LHL/HH评分≥ 1.3组的总胆红素（TB）和凝血酶原时间国际标准化比值（PT-INR）低于LHL/HH评分< 1.3组。预测评分>= 1.3组（n = 86）的TB、PT-INR和腹水量低于评分< 1.3组（n = 24）。预测评分>= 1.3的患者的6个月生存概率有所提高。总之，术前计算的LHL/HH评分与移植物功能和短期预后相关。因此，这种预测模型可以使移植外科医生更有信心地使用活体供体左叶移植物。
No reliable model for predicting early graft function and patient survival after living donor liver transplantation (LDLT) exists. The aim of this study was to establish a new formula for predicting early graft function and prognosis using technetium-99m galactosyl-human serum albumin (Tc-GSA) liver scintigraphy. The ratio of the hepatic uptake ratio of Tc-GSA to the clearance index of Tc-GSA (LHL/HH) was determined 7 days after LDLT. There were 22 patients with a ratio greater than 1.3 and 6 patients with a ratio less than 1.3. Graft function on the 14th postoperative day (POD) was compared between the 2 groups. A new formula to predict the LHL/HH score was established as follows: LHL/HH (predictive score) = 0.011 x graft weight (%) 0.016 x donor age - 0.008 x Model for End-Stage Liver Disease score - 0.15 X shunt (if present) + 1.757 (r(2) = 0.497, P < 0.01). This predicted LHL/HH ratio was compared to the graft function on POD 14 for 110 LDLT patients. The total bilirubin (TB) and prothrombin time international normalized ratio (PT-INR) in the group with an LHL/HH score >= 1.3 were lower than those in the group with an LHL/HH score < 1.3. The TB, PT-INR, and volume of ascites in the group with a predictive score >= 1.3 (n = 86) were lower than those in the group with a score < 1.3 (n = 24). The 6-month survival probability was improved in the group with a predictive score >= 1.3. In conclusion, this preoperative calculated LHL/HH score is correlated with graft function and short-term prognosis. Thus, this predictive model may allow transplant surgeons to use a living donor left lobe graft with greater confidence.