从一百例右半肝活体肝移植中吸取的经验教训。
Lessons learned from one hundred right lobe living donor liver transplants.
作者信息
Lo Chung-Mau, Fan Sheung Tat, Liu Chi Leung, Yong Boon Hun, Wong Yik, Lau George K, Lai Ching Lung, Ng Irene O, Wong John
机构信息
Centre for the Study of Liver Disease, and Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
出版信息
Ann Surg. 2004 Jul;240(1):151-8. doi: 10.1097/01.sla.0000129340.05238.a0.
OBJECTIVE
To evaluate the first 100 adult right lobe living donor liver transplants (LDLT) in a single center to determine whether the results have improved with technical modifications and better experience.
SUMMARY BACKGROUND DATA
Right lobe LDLT has been increasingly performed for adults with end-stage liver disease. Numerous modifications in technique have been introduced, and a learning curve is likely in view of its complexity.
METHODS
One hundred consecutive adult right lobe LDLTs performed between May 1996 and May 2002 were retrospectively studied by comparing the first 50 (group 1) with the last 50 cases (group 2). The median follow-up was 37 (27 to 79) months for group 1 and 15 (7 to 27) months for group 2.
RESULTS
The characteristics of donors and liver grafts were similar. In group 2, fewer recipients were intensive care unit (ICU)-bound or had hepatorenal syndrome before transplantation, and there was a lower disease severity as shown by a lower Child-Pugh score and Model for End-Stage Liver Disease (MELD) score. Significant improvements were found in the operation time, blood loss, ICU stay, and postoperative complication rate of the donors and in the operation time, transfusion requirements, number of reoperations, ICU stay, and hospital stay of the recipients in group 2. The hospital mortality rate of recipients was reduced from 16% to 0% (P = 0.006). Graft survival rates at 12 months and 24 months were improved from 80% and 74%, respectively, in group 1 to 100% and 96%, respectively, in group 2 (P = 0.002). After adjusting for differences in recipient risk factors (ICU-bound, hepatorenal syndrome, Child-Pugh score, and MELD score) in a multivariate Cox model, recipients in group 2 had significantly lower risk of graft loss (relative risk compared with group 1, 0.13; 95% CI, 0.03 to 0.66; P = 0.014).
CONCLUSIONS
There is a learning curve in adult right lobe LDLT. The results have significantly improved with technical refinement and better experience.
目的
评估单中心开展的前100例成人右半肝活体肝移植（LDLT），以确定随着技术改进和经验积累结果是否有所改善。
总结背景资料
右半肝LDLT已越来越多地应用于终末期肝病成人患者。技术上已引入诸多改进措施，鉴于其复杂性，可能存在学习曲线。
方法
回顾性研究1996年5月至2002年5月间连续进行的100例成人右半肝LDLT，将前50例（第1组）与后50例（第2组）进行比较。第1组的中位随访时间为37（27至79）个月，第2组为15（7至27）个月。
结果
供者和肝移植物的特征相似。在第2组中，移植前入住重症监护病房（ICU）或患有肝肾综合征的受者较少，且疾病严重程度较低，Child-Pugh评分和终末期肝病模型（MELD）评分均较低。第2组供者的手术时间、失血量、ICU住院时间和术后并发症发生率以及受者的手术时间、输血需求、再次手术次数、ICU住院时间和住院时间均有显著改善。受者的医院死亡率从16%降至0%（P = 0.006）。第1组12个月和24个月的移植物存活率分别从80%和74%提高到第2组的100%和96%（P = 0.002）。在多变量Cox模型中对受者风险因素（入住ICU、肝肾综合征、Child-Pugh评分和MELD评分）的差异进行校正后，第2组受者移植物丢失风险显著降低（与第1组相比，相对风险为0.13；95%可信区间，0.03至0.66；P = 0.014）。
结论
成人右半肝LDLT存在学习曲线。随着技术改进和经验积累，结果有显著改善。
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