Yamamoto Hidekazu, Maetani Yoji, Kiuchi Tetsuya, Ito Takashi, Kaihara Satoshi, Egawa Hiroto, Itoh Kyo, Kamiyama Yasuo, Tanaka Koichi
Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan.
Transplantation. 2003 Jul 15;76(1):164-9. doi: 10.1097/01.TP.0000072340.87482.17.
Although right-lobe liver grafts from living donors have been widely accepted as an option for adult patients, impact of middle hepatic vein (MHV) deprivation is a recent controversy.
Fifty recipients of right-lobe living-donor liver grafts without MHV or drainage reconstruction in anterior segment were evaluated for posttransplant tissue congestion with T2-weighted magnetic resonance imagings. Age of recipients and donors ranged from 19 to 69 (median 50) and 19 to 64 (46) years, respectively. Graft-to-recipient weight ratio ranged from 0.74% to 1.66% (1.06%). Cavoplasty was provided during right hepatic vein reconstruction to avoid anastomotic stricture.
Congestion was observed in 88% of segments V and 85% of segments VIII in the first month. Congestion positively correlated with anatomic dependency on MHV. Also, donors were significantly older in age in grafts with more congestion. However, congestion improved within several months in most grafts. Graft congestion was associated neither with morbidities nor with graft loss except for temporary correlation with ascites production in the third and fourth posttransplant weeks.
A significant proportion of right-lobe liver grafts without MHV experience morphologic congestion of the anterior segment in the early phase after transplantation, which is dependent on venous anatomy and donor age. However, the congestion spontaneously resolves in most cases. These results suggest that reconstruction of drainage vein(s) from the anterior segment is not necessary for all grafts provided good outflow through compensatory routes is secured. Additional reconstruction may be indicated in grafts with marginal size, anatomy, and quality.
尽管活体供者右半肝移植已被广泛接受为成年患者的一种选择，但肝中静脉（MHV）缺失的影响仍是近期的一个争议点。
对50例接受活体供者右半肝移植且未进行MHV或前段引流重建的受者，采用T2加权磁共振成像评估移植后组织充血情况。受者和供者的年龄分别为19至69岁（中位数50岁）和19至64岁（46岁）。移植肝与受者体重比为0.74%至1.66%（1.06%）。在右肝静脉重建过程中进行腔静脉成形术以避免吻合口狭窄。
第一个月时，88%的Ⅴ段和85%的Ⅷ段出现充血。充血与对MHV的解剖学依赖呈正相关。此外，充血较多的移植肝中供者年龄显著更大。然而，大多数移植肝中的充血在数月内有所改善。除了在移植后第三和第四周与腹水产生存在暂时相关性外，移植肝充血与发病率及移植肝丢失均无关。
相当比例的无MHV右半肝移植在移植后早期会出现前段形态学充血，这取决于静脉解剖结构和供者年龄。然而，大多数情况下充血会自发消退。这些结果表明，对于所有能通过代偿途径确保良好流出的移植肝，前段引流静脉重建并非必要。对于体积、解剖结构和质量处于边缘状态的移植肝，可能需要进行额外重建。
