University of Miami Miller School of Medicine, Miami Transplant Institute, Miami, FL, USA.
Panminerva Med. 2009 Dec;51(4):227-33.
The chronic shortage of cadaveric grafts for patients on the liver transplant list has resulted in wide implementation of living donor liver transplant (LDLT) and split cadaveric liver transplantation (SLT). Small for size syndrome (SFSS) is a significant complication that can occur during LDLT or SLT. It is generally defined as the presence of prolonged cholestasis, coagulopathy and ascites within the first week from transplant. Multiple factors contribute to the pathogenesis of SFSS, such as overall graft size, portal hyperperfusion, impaired venous outflow, as well as donor and recipient factors. Strategies utilized to minimize or resolve SFSS include the use of right lobe grafts, modulation of portal flow by splenic artery ligation, splenectomy or porto-systemic bypass, and optimization of venous outflow. Additional surgical techniques to avoid SFSS include the use of auxiliary orthotopic liver grafts and dual liver graft transplantation. Careful consideration of risk to the LDLT donor has to be taken whenever right lobe graft is utilized, especially if the middle hepatic vein (MVH) is going to be included in the graft.
慢性尸体供体短缺导致肝移植名单上的患者广泛实施活体供肝移植 (LDLT) 和劈裂尸体肝移植 (SLT)。小肝综合征 (SFSS) 是 LDLT 或 SLT 期间可能发生的一种严重并发症。它通常被定义为移植后第一周内出现持续的胆汁淤积、凝血功能障碍和腹水。多种因素导致 SFSS 的发病机制，例如总体移植物大小、门脉高灌注、静脉流出受损以及供体和受体因素。用于最小化或解决 SFSS 的策略包括使用右叶移植物、通过脾动脉结扎、脾切除术或门体分流术调节门脉血流，以及优化静脉流出。避免 SFSS 的其他手术技术包括使用辅助原位肝移植和双肝移植。在使用右叶移植物时，特别是如果中肝静脉 (MVH) 将包含在移植物中时，必须仔细考虑对 LDLT 供体的风险。
