Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Transplantation. 2010 Apr 27;89(8):1016-21. doi: 10.1097/tp.0b013e3181ce77c4.
The hepatic arteries (HAs) in a hepatic graft are usually reconstructed using the recipient's left or right HAs in living donor liver transplantation (LDLT). There have been no apparent selection criteria concerning which of the recipient's HAs should be used. This study retrospectively investigated whether the selection of left or right HA for HA reconstruction affects the outcomes of right lobe LDLT (RL-LDLT).
Ninety-nine RL-LDLT were performed between July 1998 and March 2009. After excluding 10 cases of RL-LDLT with complex HA reconstruction(s), 89 cases of RL-LDLT were divided into four groups: RL-LDLT with duct-to-duct biliary anastomosis with an HA reconstruction using the recipient's left HA (DD-L-group; n=41), the recipient's right HA (DD-R-group; n=27), RL-LDLT with hepaticojejunostomy with an HA reconstruction using the recipient's left HA (HJ-L-group; n=11), and the recipient's right HA (HJ-R-group; n=10). The outcomes of RL-LDLT were compared among these four groups.
Septic complications occurred more frequently in the DD-R-group than in the DD-L-group (2.4% vs. 22.2%, P=0.013). Furthermore, 39% of the patients in the DD-R-group suffered anastomotic biliary stricture within 2 years after transplantation, in comparison with 8.1% in the DD-L-group (P=0.003). The selection of the recipient's left or right HA did not influence patient outcomes in the case of a hepaticojejunostomy.
The DD-L-group patients experienced favorable outcomes in comparison with the DD-R-group patients. Therefore, recipient's left HAs should be selected for HA reconstruction in RL-LDLT when biliary reconstruction is performed by duct-to-duct anastomosis.
在活体肝移植（LDLT）中，肝移植的肝动脉（HA）通常使用受体的左或右 HA 进行重建。目前，对于应该使用受体的哪一侧 HA 还没有明显的选择标准。本研究回顾性调查了 HA 重建时选择左或右 HA 是否会影响右半肝 LDLT（RL-LDLT）的结果。
1998 年 7 月至 2009 年 3 月期间，共进行了 99 例 RL-LDLT。排除 10 例 HA 重建复杂的 RL-LDLT 后，将 89 例 RL-LDLT 分为 4 组：胆管端端吻合术+受体左 HA 重建 HA（DD-L 组；n=41）、胆管端端吻合术+受体右 HA 重建 HA（DD-R 组；n=27）、肝肠吻合术+受体左 HA 重建 HA（HJ-L 组；n=11）和受体右 HA 重建 HA（HJ-R 组；n=10）。比较这四组 RL-LDLT 的结果。
DD-R 组的感染性并发症发生率高于 DD-L 组（2.4%比 22.2%，P=0.013）。此外，DD-R 组中有 39%的患者在移植后 2 年内发生吻合口胆管狭窄，而 DD-L 组中只有 8.1%（P=0.003）。肝肠吻合术时，受体左或右 HA 的选择不影响患者的预后。
与 DD-R 组患者相比，DD-L 组患者的结果较好。因此，在行胆管端端吻合术时，RL-LDLT 中 HA 重建应选择受体左 HA。
