Adham Mustapha, Dumortier Jérôme, Abdelaal Amr, Sagnard Pierre, Boucaud Catherine, Boillot Olivier
Unité de transplantation hépatique-Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Lyon, France.
Liver Transpl. 2007 Jun;13(6):829-37. doi: 10.1002/lt.21133.
Preservation of the middle hepatic vein (MHV) for a right split liver transplantation (SLT) in an adult recipient is still controversial. The aim of this study was to evaluate the graft and patient outcomes after liver transplantation (LT) using a right split graft, according to the type of venous drainage. From February 2000 to May 2006, 33 patients received 34 cadaveric right split liver grafts. According to the type of recipient pairs (adult/adult or adult/child), the right liver graft was deprived of the MHV or not. The first group (GI, n = 15) included grafts with only the right hepatic vein (RHV) outflow, the second (GII, n = 18) included grafts with both right and MHV outflows. The 2 groups were similar for patient demographics, initial liver disease, and donor characteristics. In GI and GII, graft-to-recipient-weight ratio (GRWR) was 1.2 +/- 0% and 1.6 +/- 0.3% (P < 0.05), and cold ischemia time was 10 hours 55 minutes +/- 2 hours 49 minutes and 10 hours 47 minutes +/- 3 hours 32 minutes, respectively (P = not significant). Postoperative death occurred in 1 patient in each group. Vascular complications included anastomotic strictures: 2 portal vein (PV), 1 hepatic artery (HA), and 1 RHV anastomotic strictures; all in GI. Biliary complications occurred in 20% and 22% of the patients, in GI and GII, respectively (P = not significant). There were no differences between both groups regarding postoperative outcome and blood tests at day 1-15 except for a significantly higher cholestasis in GI. At 1 and 3 yr, patient survival was 94% for both groups and graft survival was 93% for GI and 90% for GII (P = not significant). In conclusion, our results suggest that adult right SLT without the MHV is safe and associated with similar long-term results as compared with those of the right graft including the MHV, despite that early liver function recovered more slowly. Technical refinements in outflow drainage should be evaluated in selected cases.
在成人受体的右半肝移植（SLT）中保留肝中静脉（MHV）仍存在争议。本研究的目的是根据静脉引流类型评估使用右半肝移植物进行肝移植（LT）后的移植物和患者结局。2000年2月至2006年5月，33例患者接受了34例尸体右半肝移植物。根据受体配对类型（成人/成人或成人/儿童），右肝移植物是否保留MHV。第一组（GI，n = 15）包括仅通过右肝静脉（RHV）流出的移植物，第二组（GII，n = 18）包括通过右肝静脉和MHV流出的移植物。两组在患者人口统计学、初始肝病和供体特征方面相似。在GI组和GII组中，移植物与受体体重比（GRWR）分别为1.2±0%和1.6±0.3%（P < 0.05），冷缺血时间分别为10小时55分钟±2小时49分钟和10小时47分钟±3小时32分钟（P = 无显著性差异）。每组各有1例患者术后死亡。血管并发症包括吻合口狭窄：2例门静脉（PV）、1例肝动脉（HA）和1例RHV吻合口狭窄；均发生在GI组。GI组和GII组分别有20%和22%的患者发生胆道并发症（P = 无显著性差异）。除GI组胆汁淤积明显较高外，两组在术后1 - 15天的结局和血液检查方面无差异。在1年和3年时，两组患者生存率均为94%，GI组移植物生存率为93%，GII组为90%（P = 无显著性差异）。总之，我们的结果表明，不保留MHV的成人右半肝移植是安全的，与保留MHV的右半肝移植物相比，长期结果相似，尽管早期肝功能恢复较慢。应在特定病例中评估流出道引流的技术改进。
