Yan Lii-nan, Li Bo, Zeng Yong, Wen Tian-fu, Wang Wen-tao, Yang Jia-yin, Xu Ming-qing, Chen Zhe-yu, Zhao Ji-chun, Ma Yu-kui, Wu Hong
Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2007 Jun;38(3):513-7.
To investigate the safety of adult-to-adult living donor liver transplantation (AALDLT), which means how to make the life safeties of both adult donor and recipient who are transplanted with the right lobe of liver.
From January 2002 to July 2006, 50 A-ALDLT were performed at West China Hospital, Sichuan University, which consisted of 47 cases with right lobe graft without middle hepatic vein (MHV) and 3 cases with the dual graft of liver lobes (one cases with two left lobes, 2 with one right and one left lobe). The majority of adult liver recipients suffered originally from the hepatitis B with liver cirrhosis (60%), hepatocellular carcinoma (30%) as primary diseases, and 10 cases among them had the model of end-stage liver disease (MELD) score more than 25. The grafting livers of donors were routinely scanned under three-dimensional computed tomography (CT), and the scan image data were computed for volume reconstructions of whole and right lobe livers. Various innovative surgical techniques were adopted for donor and recipient procedure operation.
From 52 living donors, 49 right liver lobes and 3 left lobes were obtained. The 49 right lobe grafts without MHV were weighed to 400-850 g (medial 550 g). The ratios of the graft volumes to the volumes of recipient standard livers (GV/SLV) were ranged from 31. 74% to 71. 68% (mean, 45. 35%). All of the donor remnant liver volumes were larger 35% of the whole liver volume. There was no donor mortality occurring, but 7. 69% of donors undergoing complications in 50 adult recipients. With postoperatively following up 2-52 months (medial 9 months), 13 (26%) occurred various complications and 4 (8%) died within 3 months. Their 1-y actual survival rate was 92%. CONCLUSION When preoperative CT volume showed the volume of remnant liver is greater than 35% of whole liver volume, and the ratio of right lobe graft volume to recipient's standard live volume is more than 40% , A-ALDLT using right lobe graft should be very safe procedure for both donors and recipients, otherwise the dual graft liver transplantation should be considered.
探讨成人活体肝移植（AALDLT）的安全性，即如何保障接受右半肝移植的成年供体和受体的生命安全。
2002年1月至2006年7月，四川大学华西医院共进行了50例成人活体肝移植手术，其中47例为无肝中静脉（MHV）的右半肝移植，3例为肝叶联合移植（1例为双左半肝，2例为右半肝与左半肝各一叶）。大多数成年肝受体原发病为乙型肝炎肝硬化（60%）、肝细胞癌（30%），其中10例终末期肝病模型（MELD）评分大于25分。供体移植肝脏常规行三维计算机断层扫描（CT），扫描图像数据用于全肝及右半肝体积重建。供体和受体手术操作采用了多种创新手术技术。
从52例活体供体中获取了49个右半肝和3个左半肝。49个无肝中静脉的右半肝移植肝重量为400～850g（平均550g）。移植肝体积与受体标准肝体积（GV/SLV）之比为31.74%～71.68%（平均45.35%）。所有供体剩余肝体积均大于全肝体积的35%。供体无死亡病例，但50例成年受体中有7.69%的供体出现并发症。术后随访2～52个月（平均9个月），13例（26%）出现各种并发症，4例（8%）在3个月内死亡。其1年实际生存率为92%。结论术前CT显示剩余肝体积大于全肝体积的35%，且右半肝移植肝体积与受体标准肝体积之比大于40%时，则采用右半肝移植的成人活体肝移植对供体和受体均应是非常安全的手术，否则应考虑行联合肝移植。
