Asakuma M, Fujimoto Y, Bourquain H, Uryuhara K, Hayashi M, Tanigawa N, Peitgen H-O, Tanaka K
Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, Kyoto, Japan.
Am J Transplant. 2007 Jul;7(7):1788-96. doi: 10.1111/j.1600-6143.2007.01849.x. Epub 2007 May 25.
A major concern in adult-to-adult living donor liver transplantation is the selection of graft type; that is, is it is better to use the right lobe with or without the middle hepatic vein (MHV)? This choice has a considerable impact on donor safety, vascular reconstruction and graft function in the recipient. To facilitate making an appropriate choice, on the basis of a preliminary study (n = 17), we herein propose a graft selection algorithm using three parameters: graft-to-recipient body weight ratio (GRWR), percentage remnant liver volume (%RLV) and estimated congestion ratio (ECR). The algorithm was evaluated with 50 consecutive cases with respect to postoperative liver function of donors and recipients and survival of recipients. Postoperative recovery was comparable between the two groups (p = NS). The overall cumulative 18-month survival rate was 86.7% for the 'with MHV graft group', and 76.1% for the gwithout MHV graft grouph (p = NS). For 41 cases (82%), graft types were chosen according to the algorithm, whereas the remaining 9 cases (18%) needed detailed discussion of donor, recipient and operative factors. In conclusion, we constructed a graft selection algorithm based on congestion volume, which will contribute to objective graft-type selection in adult-to-adult LDLT.
成人对成人活体肝移植中的一个主要问题是移植物类型的选择；也就是说，使用含或不含肝中静脉（MHV）的右叶哪个更好？这一选择对供体安全性、血管重建以及受体的移植物功能都有相当大的影响。为便于做出合适的选择，基于一项初步研究（n = 17），我们在此提出一种使用三个参数的移植物选择算法：移植物与受体体重比（GRWR）、残余肝体积百分比（%RLV）和估计充血率（ECR）。该算法针对50例连续病例的供体和受体术后肝功能以及受体生存率进行了评估。两组术后恢复情况相当（p = 无显著差异）。“含MHV移植物组”的18个月总体累积生存率为86.7%，“不含MHV移植物组”为76.1%（p = 无显著差异）。41例（82%）的移植物类型是根据该算法选择的，而其余9例（18%）则需要对供体、受体和手术因素进行详细讨论。总之，我们构建了一种基于充血量的移植物选择算法，这将有助于在成人对成人活体肝移植中进行客观的移植物类型选择。
