Yoshizumi Tomoharu, Taketomi Akinobu, Soejima Yuji, Ikegami Toru, Uchiyama Hideaki, Kayashima Hiroto, Harada Noboru, Yamashita Yo-ichi, Kawanaka Hirofumi, Nishizak Takashi, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Transpl Int. 2008 Sep;21(9):833-42. doi: 10.1111/j.1432-2277.2008.00678.x. Epub 2008 May 13.
Small-for-size (SFS) graft syndrome is one of the major causes of graft loss in living donor liver transplantation (LDLT). We examined whether splenectomy is beneficial for overcoming SFS graft syndrome in LDLT. The patients were classified into two groups: the Sp (-) group (n=69), in which splenectomy was not performed, and the Sp (+) group (n=44), in which it was. The incidence of SFS graft syndrome was investigated. Risk factors of SFS graft syndrome were identified by univariate- and multivariate analysis. To clarify whether splenectomy is beneficial for patients with a SFS graft, subgroup analysis was performed for patients who had a graft weight-to-standard liver weight (GW-SLW) ratio of 40% or less (n=50). Thirty-one of 113 patients developed SFS graft syndrome. A multivariate analysis identified that having a male donor was an independent risk factor of SFS graft syndrome. SFS graft syndrome occurred in 11 of 50 patients with a GW-SLW ratio<40%, and Sp (-) was an independent risk factor for the occurrence of SFS graft syndrome in patients (P=0.014). Simultaneous splenectomy is favorable for overcoming SFS graft syndrome in LDLT patients with a GW-SLW of 40% or less.
小体积移植物综合征是活体肝移植（LDLT）中移植物丢失的主要原因之一。我们研究了脾切除术是否有助于克服LDLT中的小体积移植物综合征。患者被分为两组：未进行脾切除术的Sp（-）组（n = 69）和进行了脾切除术的Sp（+）组（n = 44）。调查了小体积移植物综合征的发生率。通过单因素和多因素分析确定小体积移植物综合征的危险因素。为了阐明脾切除术对小体积移植物患者是否有益，对移植物重量与标准肝脏重量（GW-SLW）比值为40%或更低的患者（n = 50）进行了亚组分析。在113例患者中，31例发生了小体积移植物综合征。多因素分析确定供体为男性是小体积移植物综合征的独立危险因素。在50例GW-SLW比值<40%的患者中，11例发生了小体积移植物综合征，Sp（-）是患者发生小体积移植物综合征的独立危险因素（P = 0.014）。对于GW-SLW为40%或更低的LDLT患者，同时进行脾切除术有利于克服小体积移植物综合征。
