Gu Yanli, Dirsch Olaf, Dahmen Uta, Ji Yuan, He Qing, Chi Haidong, Broelsch Christoph Erich
Department of General Surgery and Transplantation Surgery, University Hospital Duisburg-Essen, Essen, Germany.
Liver Transpl. 2005 Jun;11(6):669-78. doi: 10.1002/lt.20408.
The aim of this study was to assess the impact of donor gender on small-for-size (SFS) liver transplantation in male recipients using a rat model. Adult female or male Lewis rats were used as donors and male Lewis rats as recipients. Size-matched (SM) and SFS liver grafts from either male or female donors were transplanted into male recipients. Animals receiving SFS grafts were sacrificed at postoperative week 1, week 4, and week 12, respectively (n = 6-8 per group), those receiving SM grafts after 3 months. The cumulative survival rate (SVR) in the female-to-male (F-M) SFS group was significantly lower (62%; 13 of 21) compared with the male-to-male (M-M) group (90%; 18 of 20) (P < 0.05). Spontaneous death occurred in the F-M SFS combination either in the early postoperative period (<3 weeks) in animals with confluent hepatic necrosis or in the late postoperative period (>8 weeks) in animals with biliary obstruction. In contrast, no death was observed in the early posttransplantation period after M-M liver transplantation. The relative graft size in the SM F-M group was significantly higher (graft-to-recipient weight ratio [GRWR] 2.40% +/- 0.8%) than in the SFS M-M group (GRWR 1.35% +/- 0.2%; P < 0.001). Regardless of graft size, the outcome was worse in terms of SVR as well as regarding the incidence and severity of biliary complications in F-M compared with M-M liver transplantation. In conclusion, male recipients of female livers had a less favorable outcome irrespective of graft size. Confluent hepatic necrosis as well as biliary obstruction were perceived as consequence of a severe perfusion problem in F-M liver transplantation, which was possibly related to an enhancement of ischemia-reperfusion (I/R) injury by the lack of estrogen in male recipients of female grafts.
本研究旨在使用大鼠模型评估供体性别对男性受体小体积（SFS）肝移植的影响。成年雌性或雄性Lewis大鼠用作供体，雄性Lewis大鼠用作受体。将来自雄性或雌性供体的大小匹配（SM）和SFS肝移植物移植到雄性受体中。接受SFS移植物的动物分别在术后第1周、第4周和第12周处死（每组n = 6 - 8），接受SM移植物的动物在3个月后处死。雌性供体到雄性受体（F - M）SFS组的累积生存率（SVR）显著低于雄性供体到雄性受体（M - M）组（62%；21只中的13只）（90%；20只中的18只）（P < 0.05）。F - M SFS组合中，自发性死亡发生在术后早期（<3周）合并肝坏死的动物中，或术后晚期（>8周）发生胆道梗阻的动物中。相比之下，M - M肝移植术后早期未观察到死亡。SM F - M组的相对移植物大小显著高于SFS M - M组（移植物与受体重量比[GRWR] 2.40% +/- 0.8%）（GRWR 1.35% +/- 0.2%；P < 0.001）。无论移植物大小如何，与M - M肝移植相比，F - M肝移植在SVR以及胆道并发症的发生率和严重程度方面的结果更差。总之，无论移植物大小如何，接受雌性肝脏的男性受体预后较差。合并肝坏死以及胆道梗阻被认为是F - M肝移植中严重灌注问题的结果，这可能与雌性移植物男性受体中缺乏雌激素导致的缺血再灌注（I/R）损伤增强有关。
