Ben-Haim M, Emre S, Fishbein T M, Sheiner P A, Bodian C A, Kim-Schluger L, Schwartz M E, Miller C M
The Recanati/Miller Transplantation Institute, The Mount Sinai School of Medicine, New York, NY, USA.
Liver Transpl. 2001 Nov;7(11):948-53. doi: 10.1053/jlts.2001.29033.
The aim of this study is to analyze the impact of the recipient's disease severity on graft size requirements and outcome in adult-to-adult living donor liver transplantation. A limiting factor in adult-to-adult living donor liver transplantation has been adequacy of graft size. A minimal graft-recipient weight ratio (GRWR) of 0.8% to 1% has been suggested, without taking the recipient's disease into account. Forty adults underwent liver transplantation using left (n = 10; mean weight, 481 +/- 83 g) or right lobes (n = 30; mean weight, 845 +/- 182 g). We recorded graft survival, Child-Turcotte-Pugh score, and occurrence of small-for-size syndrome (poor bile production, prolonged postoperative prothrombin time, and cholestasis without ischemia markers). Small grafts were defined as GRWR of < or =0.85%. Large grafts were defined as GRWR greater than 0.85%. Six patients died within 6 months of transplantation (early patient survival rate, 85%); two patients died late of tumor recurrence. Among transplant recipients with normal liver function or Child's class A, there was no significant difference with the use of small (n = 6) or large (n = 9) grafts (graft survival rates, 83% v 88%, respectively; P =.65). Among patients with Child's class B or C, graft survival rates were 74% in recipients of large grafts (n = 19) and 33% in recipients of small grafts (n = 6; P =.023). Five of 6 patients with Child's class B or C who received small grafts developed small-for-size syndrome; 2 patients died (1 patient after retransplantation) and 3 patients survived (2 patients after retransplantation). Graft function and survival are influenced not only by graft size, but also by pretransplantation disease severity. GRWR as low as 0.6% can be used safely in patients without cirrhosis or in patients with Child's class A. Transplant recipients with Child's class B or C require a GRWR greater than 0.85% to avoid small-for-size syndrome and related complications.
本研究的目的是分析在成人对成人活体肝移植中，受者疾病严重程度对移植物大小需求及预后的影响。成人对成人活体肝移植中的一个限制因素是移植物大小是否足够。有人建议最小移植物与受者体重比（GRWR）为0.8%至1%，但未考虑受者的疾病情况。40名成人接受了肝移植，其中10人使用左叶移植物（平均重量，481±83克），30人使用右叶移植物（平均重量，845±182克）。我们记录了移植物存活情况、Child-Turcotte-Pugh评分以及小肝综合征的发生情况（胆汁分泌不良、术后凝血酶原时间延长以及无缺血标志物的胆汁淤积）。小移植物定义为GRWR≤0.85%。大移植物定义为GRWR大于0.85%。6例患者在移植后6个月内死亡（早期患者存活率为85%）；2例患者后期死于肿瘤复发。在肝功能正常或Child A级的移植受者中，使用小移植物（n = 6）或大移植物（n = 9）没有显著差异（移植物存活率分别为83%对88%；P = 0.65）。在Child B级或C级患者中，大移植物受者（n = 19）移植物存活率为74%，小移植物受者（n = 6）为33%（P = 0.023）。6例接受小移植物的Child B级或C级患者中有5例发生了小肝综合征；2例患者死亡（1例在再次移植后），3例患者存活（2例在再次移植后）。移植物功能和存活不仅受移植物大小影响，还受移植前疾病严重程度影响。对于无肝硬化或Child A级的患者，GRWR低至0.6%也可安全使用。Child B级或C级的移植受者需要GRWR大于0.85%以避免小肝综合征及相关并发症。
