Hong Johnny C, Yersiz Hasan, Farmer Douglas G, Duffy John P, Ghobrial R Mark, Nonthasoot Bunthoon, Collins Thomas E, Hiatt Jonathan R, Busuttil Ronald W
Department of Surgery, Dumont-UCLA Transplant Center, Pfleger Liver Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA 90095-7054, USA.
J Am Coll Surg. 2009 May;208(5):682-9; discusion 689-91. doi: 10.1016/j.jamcollsurg.2009.01.023. Epub 2009 Mar 26.
Data on longterm outcomes after liver transplantation with partial grafts are limited. We compared 10-year outcomes for liver transplant patients who received whole grafts (WLT), split grafts from deceased donors (SLT), and partial grafts from living donors (LDLT).
We conducted a single-center analysis of 2,988 liver transplantations performed between August 1993 and May 2006 with median followup of 5 years. Graft types included 2,717 whole-liver, 181 split-liver, and 90 living-donor partial livers. Split-liver grafts included 109 left lateral and 72 extended right partial livers. Living-donor grafts included 49 left lateral and 41 right partial livers.
The 10-year patient survivals for WLT, SLT, and LDLT were 72%, 69%, and 83%, respectively (p=0.11), and those for graft survival were 62%, 55%, and 65%, respectively (p=0.088). There were differences in outcomes between adults and children when compared separately by graft types. In adults, 10-year patient survival was significantly lower for split extended right liver graft compared with adult whole liver and living-donor right liver graft (57% versus 72% versus 75%, respectively, p=0.03). Graft survival for adults was similar for all graft types. Retransplantation, recipient age older than 60 years, donor age older than 45 years, split extended right liver graft, and cold ischemia time>10 hours were predictors of diminished patient survival outcomes. In children, the 10-year patient and graft survivals were similar for all graft types.
Longterm graft survival rates in both adults and children for segmental grafts from deceased and living donors are comparable with those in whole organ liver transplantation. In adults, patient survival was lower for split compared with whole grafts when used in retransplantations and in critically ill recipients. Split graft-to-recipient matching is crucial for optimal organ allocation and best use of a scarce and precious resource.
部分肝移植后的长期预后数据有限。我们比较了接受全肝移植（WLT）、来自已故供体的劈裂肝移植（SLT）和来自活体供体的部分肝移植（LDLT）的肝移植患者的10年预后情况。
我们对1993年8月至2006年5月期间进行的2988例肝移植进行了单中心分析，中位随访时间为5年。移植类型包括2717例全肝、181例劈裂肝和90例活体供体部分肝。劈裂肝移植包括109例左外叶和72例右半肝扩大切除术。活体供体移植包括49例左外叶和41例右半肝。
WLT、SLT和LDLT的10年患者生存率分别为72%、69%和83%（p=0.11），移植生存率分别为62%、55%和65%（p=0.088）。按移植类型分别比较时，成人和儿童的预后存在差异。在成人中，与成人全肝和活体供体右肝移植相比，右半肝扩大切除术的劈裂肝移植的10年患者生存率显著较低（分别为57%、72%和75%，p=0.03）。所有移植类型的成人移植生存率相似。再次移植、受者年龄大于60岁、供者年龄大于45岁、右半肝扩大切除术的劈裂肝移植以及冷缺血时间>10小时是患者生存预后降低的预测因素。在儿童中，所有移植类型的10年患者和移植生存率相似。
来自已故和活体供体的节段性移植在成人和儿童中的长期移植生存率与全器官肝移植相当。在成人中，用于再次移植和重症受者时，劈裂肝移植的患者生存率低于全肝移植。劈裂肝与受者的匹配对于优化器官分配和充分利用稀缺而宝贵的资源至关重要。
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