Left Lobe Living Donor Liver Transplantation in Adults
Left Lobe Living Donor Liver Transplantation in Adults
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DOI：
10.1111/j.1600-6143.2012.04022.x
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发表时间：
2012-07-01
影响因子：
8.8
通讯作者：
Maehara, Y.
中科院分区：
文献类型：
--
作者：
Soejima, Y.;Shirabe, K.;Maehara, Y.
由于移植物尺寸的问题，成人左叶（LL）活体肝移植（LDLT）尚未被普遍认为是可行的手术。本研究的目的是评估成人 LL LDLT 与右叶 (RL) LDLT 相比的可行性以及短期和长期结果。对 200 例连续 LL LDLT（包括 5 例再移植）的数据与 112 例 RL LDLT 的生存率、并发症和供体发病率进行回顾性比较。 LL 移植物的平均移植物重量与标准体积之比为 38.7%，而 RL 移植物的平均移植物重量与标准体积之比为 47.6% (p < 0.0001)。 LL LDLT 的 1 年、5 年和 10 年患者生存率分别为 85.6%、77.9% 和 69.5%，与 RL LDLT 的患者生存率（分别为 89.8%、71.3% 和 70.7%）相当。 LL LDLT 中小尺寸综合征的发生率 (19.5%) 高于 RL LDLT 中 (7.1%) (p < 0.01)。 LL (36.0%) 和 RL (34.8%) 之间的总体供体发病率相当，而 LL 供体的术后肝功能测试和住院时间明显更好 (p < 0.0001)。总之，成人 LL LDLT 的结果与 RL LDLT 相当。 LL LDLT 可行，是成人 LDLT 的首选。
Adult left lobe (LL) living donor liver transplantation (LDLT) has not generally been recognized as a feasible procedure because of the problem of graft size. The objectives of this study were to assess the feasibility and short- and long-term results of adult LL LDLT in comparison with right lobe (RL) LDLT. Data on 200 consecutive LL LDLTs, including five retransplants, were retrospectively compared with those of 112 RL LDLTs, in terms of survival, complications and donor morbidity. The mean graft weight to standard volume ratio of LL grafts was 38.7% whereas that of RL grafts was 47.6% (p < 0.0001). The 1-, 5- and 10-year patient survival rates of LL LDLT were 85.6%, 77.9% and 69.5%, respectively, which were comparable to those of RL LDLT (89.8%, 71.3% and 70.7%, respectively). The incidence of small-for-size syndrome was higher in LL LDLT (19.5%) than in RL LDLT (7.1%) (p < 0.01). The overall donor morbidity rates were comparable between LL (36.0%) and RL (34.8%), whereas postoperative liver function tests and hospital stay were significantly better (p < 0.0001) in LL donors. In conclusion, adult LL LDLT has comparable outcomes to that of RL LDLT. LL LDLT is viable and is the first choice in adult LDLT.