Ghobrial R M, Yersiz H, Farmer D G, Amersi F, Goss J, Chen P, Dawson S, Lerner S, Nissen N, Imagawa D, Colquhoun S, Arnout W, McDiarmid S V, Busuttil R W
Dumont-UCLA Transplant Center, Departments of Surgery and Pediatrics, University of California Los Angeles School of Medicine and the Cedars Sinai Center for Liver Diseases and Transplantation, Los Angeles, California 90095, USA.
Ann Surg. 2000 Sep;232(3):312-23. doi: 10.1097/00000658-200009000-00003.
To determine the factors that influence patient survival after in vivo split liver transplantation (SLT).
Split liver transplantation is effective in expanding the donor pool, and its use reduces the number of deaths in patients awaiting orthotopic liver transplantation. Early SLTs were associated with poor outcomes, and acceptance of the technique has been slow. A better understanding of the factors that influence patient and graft survival would be useful in widening the application of SLT.
During a 3.5-year period, 55 right and 55 left lateral in vivo split grafts were transplanted in 102 pediatric and adult recipients. The authors' in vivo split technique has been previously described. Median follow-up was 14.5 months. Recipient, donor, and surgical variables were analyzed for their effect on patient survival after SLT.
Overall survival rates of patients who received an SLT were not significantly different from those of patients who received whole organ transplants. Survival of left lateral segment recipients, at median follow-up time, was 76% versus 80% in patients receiving a trisegment. Fifty of 102 patients (49%) were high-risk urgent recipients (United Network for Organ Sharing [UNOS] status 1 and 2A) and 52 (51%) were nonurgent recipients (UNOS status 2B, 3). High-risk recipients had a survival rate significantly lower than that of nonurgent recipients. By univariate comparison, two variables-UNOS status and number of transplants per patient-were significantly associated with an increased risk of death. Preoperative recipient mechanical ventilation, preoperative prothrombin time, donor sodium level, donor length of hospital stay, and warm ischemia time approached significance. The type of graft (right vs. left) did not reduce the survival rate after transplantation. Multivariate logistic regression analysis identified UNOS status and length of donor hospital stay as independent predictors of survival.
Patient survival of in vivo SLT is not significantly different from that of whole-organ orthotopic liver transplantation. The variables affecting outcome of in vivo SLT are similar to those in whole-organ transplantation. in vivo SLT should be widely applied to expand a severely depleted donor pool.
确定影响活体肝移植（SLT）后患者生存的因素。
活体肝移植在扩大供体库方面有效，其应用减少了等待原位肝移植患者的死亡人数。早期的活体肝移植与不良预后相关，该技术的接受度一直较低。更好地了解影响患者和移植物生存的因素将有助于扩大活体肝移植的应用范围。
在3.5年的时间里，将55个右半肝和55个左外叶活体肝移植物移植给102名儿童和成人受者。作者的活体肝分割技术此前已有描述。中位随访时间为14.5个月。分析受者、供者和手术变量对活体肝移植后患者生存的影响。
接受活体肝移植患者的总体生存率与接受全器官移植患者的总体生存率无显著差异。在中位随访时间，左外叶肝段受者的生存率为76%，而接受三叶肝移植患者的生存率为80%。102例患者中有50例（49%）为高危紧急受者（器官共享联合网络[UNOS]状态1和2A），52例（51%）为非紧急受者（UNOS状态2B、3）。高危受者的生存率显著低于非紧急受者。通过单变量比较，两个变量——UNOS状态和每位患者的移植次数——与死亡风险增加显著相关。术前受者机械通气、术前凝血酶原时间、供者钠水平、供者住院时间和热缺血时间接近显著水平。移植物类型（右半肝与左外叶）并未降低移植后的生存率。多变量逻辑回归分析确定UNOS状态和供者住院时间为生存的独立预测因素。
活体肝移植患者的生存率与原位全器官肝移植患者的生存率无显著差异。影响活体肝移植结果的变量与全器官移植中的变量相似。活体肝移植应广泛应用以扩大严重枯竭的供体库。
Zotero 插件