Broering Dieter C, Topp Stefan, Schaefer Ulrich, Fischer Lutz, Gundlach Matthias, Sterneck Martina, Schoder Volker, Pothmann Werner, Rogiers Xavier
Department of Hepatobiliary Surgery and Transplantation, University Hospital-Eppendorf, University of Hamburg, Germany.
J Am Coll Surg. 2002 Nov;195(5):648-57. doi: 10.1016/s1072-7515(02)01339-x.
The technique of liver splitting is an effective way of increasing the donor pool and reducing pediatric waiting list mortality. But the procedure is still not fully accepted because of concerns that it may cause complications in adult recipients.
Fifty-nine adult recipients of primary extended right split liver transplantations (SLTs) were matched to recipients of whole liver transplantations (WLTs) according to the following criteria: 1) United Network for Organ Sharing (UNOS) status, 2) donor age, 3) recipient age, 4) total cold ischemic time, 5) indication for liver transplantation, 6) Child-Pugh class, and 7) year of transplantation. A WLT-recipient match was identified in 40 adult recipients of primary SLT.
Fifteen percent of the recipients in our study were highly urgent cases (UNOS 1), and 85% were UNOS status 3-4. The 3- and 12-month patient survival rates after SLT and WLT were 82.5% and 77.1%, and 92.5% and 87.5%, respectively (log rank p = 0.358). The 3- and 12-month graft survival rates showed no significant difference in either group (80% and 74% in SLT and 87.5% and 77.4% in WLT [log rank p = 0.887]). The rates of primary nonfunction, primary poor function, biliary and vascular complications, intra- and postoperative blood transfusion, and intensive care stay were comparable for SLT and WLT.
SLT, using the extended right hepatic lobe, does not notably differ from WLT with regard to initial graft function, postoperative complications, or patient and graft survival. Based on this, the liver can be considered a paired organ, and mandatory splitting of good-quality livers can be recommended.
肝脏劈裂技术是增加供体库和降低儿童等待名单死亡率的有效方法。但由于担心该手术可能会在成年受者中引发并发症，该手术仍未被完全接受。
59例接受初次扩大右半肝移植（SLT）的成年受者，根据以下标准与全肝移植（WLT）受者进行匹配：1）器官共享联合网络（UNOS）状态；2）供体年龄；3）受者年龄；4）总冷缺血时间；5）肝移植指征；6）Child-Pugh分级；7）移植年份。在40例接受初次SLT的成年受者中找到了WLT受者匹配对象。
我们研究中的15%受者为高度紧急病例（UNOS 1级），85%为UNOS 3 - 4级。SLT和WLT后3个月和12个月的患者生存率分别为82.5%和77.1%，以及92.5%和87.5%（对数秩检验p = 0.358）。两组的3个月和12个月移植物生存率均无显著差异（SLT组为80%和74%，WLT组为87.5%和77.4%[对数秩检验p = 0.887]）。SLT和WLT在原发性无功能、原发性功能不良、胆道和血管并发症、术中及术后输血以及重症监护停留时间方面的发生率相当。
使用扩大右肝叶的SLT在初始移植物功能、术后并发症或患者及移植物生存率方面与WLT并无显著差异。基于此，肝脏可被视为成对器官，建议对优质肝脏进行强制性劈裂。
