Ogawa Kohei, Kasahara Mureo, Sakamoto Seisuke, Ito Takashi, Taira Kaoru, Oike Fumitaka, Ueda Mikiko, Egawa Hiroto, Takada Yasutsugu, Uemoto Shinji
Department of Surgery, Kyoto University, Kyoto, Japan.
Transplantation. 2007 May 27;83(10):1337-40. doi: 10.1097/01.tp.0000263340.82489.18.
In pediatric living donor liver transplantation, left lateral segment or monosegmental graft is used to overcome size discrepancies between adult donors and pediatric recipients. For neonates and extremely small infants, however, problems related to large-for-size graft are sometimes encountered even when using such grafts. The reduced monosegmental graft, in which the caudal part of the monosegmental graft is resected, has been introduced to address this problem.
Of 566 children who underwent transplant between June 1990 and September 2004, reduced monosegment living donor liver transplants were used for nine patients (median age, 144 days; median weight, 4.1 kg). This technique was used for infants with estimated graft-to-recipient weight ratio (GRWR) > or =4.0% when using the left lateral segment.
Graft and patient survival was 66.7%. GRWR was reduced from 7.45+/-2.70% to 3.39+/-0.89% using this modification. Transaminase levels at days 1 and 2 after transplantation were significantly higher in reduced monosegmental transplantation than in left lateral segmental transplantation. Hepatic artery thrombosis and portal vein thrombosis were observed in one case each.
Reduced monosegmental living donor liver transplantation represents a feasible option for neonates and extremely small infants with liver failure.
在小儿活体肝移植中，使用左外侧叶或单节段移植物来克服成人供体与小儿受体之间的尺寸差异。然而，对于新生儿和极小的婴儿，即使使用此类移植物，有时也会遇到与移植物过大相关的问题。已引入减少单节段移植物，即切除单节段移植物的尾部部分，以解决这一问题。
在1990年6月至2004年9月期间接受移植的566名儿童中，9名患者（中位年龄144天；中位体重4.1千克）接受了减少单节段活体肝移植。当使用左外侧叶时，该技术用于估计移植物与受体体重比（GRWR）≥4.0%的婴儿。
移植物和患者生存率为66.7%。使用这种改良方法后，GRWR从7.45±2.70%降至3.39±0.89%。减少单节段移植术后第1天和第2天的转氨酶水平显著高于左外侧叶移植。各观察到1例肝动脉血栓形成和门静脉血栓形成。
减少单节段活体肝移植是新生儿和极小的肝功能衰竭婴儿的一种可行选择。
