Kyoden Yusuke, Tamura Sumihito, Sugawara Yasuhiko, Akamatsu Nobuhisa, Matsui Yuichi, Togashi Junichi, Kaneko Junichi, Makuuchi Masatoshi
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Transpl Int. 2008 Apr;21(4):332-9. doi: 10.1111/j.1432-2277.2007.00613.x. Epub 2007 Dec 5.
Biliary complications remain the most challenging issue in adult living donor liver transplantation (LDLT) and to the best of our knowledge, no study has focused on the biliary complications in LDLT with right lateral sector graft (RLSG), a graft consisting of segments VI and VII according to Couinaud's nomenclature for liver segmentation. Between January 1996 and October 2006, 310 LDLTs were performed for adult recipients at our institution. Among them, 20 patients received RLSG. The incidence of biliary complications during follow-up in these patients with RLSG was retrospectively analyzed. Follow-up period after transplantation ranged from 1 to 87 months (median 58 months). The 3-year and 5-year graft survival rates following the use of RLSGs in LDLT were 90% and 90%, respectively. Biliary complications were encountered in altogether nine patients. Two patients (10%) were complicated with bile leakage requiring surgical intervention. Seven patients (35%) were complicated with bile duct stenosis, which occurred with a median interval of 26 months (range: 6-51 months) after LDLT. Four were treated surgically and the other three were treated by endoscopic approach. Outcomes of the interventions were satisfactory in all cases. The incidence and severity of biliary complications after LDLT using RLSG was within an acceptable range with excellent graft survival. Accordingly, it is concluded that RLSG is a technically feasible option that may effectively expand the donor pool. Further application of RLSG is warranted.
胆道并发症仍然是成人活体肝移植（LDLT）中最具挑战性的问题。据我们所知，尚无研究聚焦于采用右外侧叶移植物（RLSG）的LDLT中的胆道并发症，RLSG是一种根据Couinaud肝脏分段命名法由第VI和VII段组成的移植物。1996年1月至2006年10月期间，我院为成年受者实施了310例LDLT。其中，20例患者接受了RLSG。对这些接受RLSG患者随访期间胆道并发症的发生率进行了回顾性分析。移植后的随访期为1至87个月（中位时间58个月）。LDLT中使用RLSG后的3年和5年移植物存活率分别为90%和90%。共有9例患者出现胆道并发症。2例患者（10%）并发胆漏，需要手术干预。7例患者（35%）并发胆管狭窄，发生在LDLT后的中位间隔时间为26个月（范围：6 - 51个月）。4例接受手术治疗，另外3例接受内镜治疗。所有病例干预结果均令人满意。使用RLSG的LDLT后胆道并发症的发生率和严重程度在可接受范围内，移植物存活率良好。因此，得出结论，RLSG是一种技术上可行的选择，可有效扩大供体库。RLSG值得进一步应用。
