Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Liver Transpl. 2011 Sep;17(9):1046-58. doi: 10.1002/lt.22338.
To determine the feasibility of volumetric criteria without anatomic exclusion for the selection of right posterior sector (RPS) grafts for adult-to-adult living donor liver transplantation (LDLT), we reviewed and compared our transplant data for RPS grafts and right lobe (RL) grafts. Between January 2008 and September 2010, adult-to-adult LDLT was performed 65 times at our institute; 13 of the procedures (20%) were performed with RPS grafts [the posterior sector (PS) group], and 39 (60%) were performed with RL grafts (the RL group). The volumetry of the 13 RPS donor livers showed that the RPS volume was 39.8% ± 7.6% of the total liver volume. Ten of the 13 donors had to donate RPS grafts because the left liver volume was inadequate. All donor procedures were performed successfully, and all donors recovered from hepatectomy. However, longer operative times were required for the procurement of RPS grafts versus RL grafts (418 ± 40 versus 345 ± 48 minutes, P < 0.001). The postoperative recovery of liver function was smoother for the donors of the PS group versus the donors of the RL group. The RPS grafts had significantly smaller hepatic artery and bile duct openings than the RL grafts. All recipients with RPS grafts survived LDLT. No recipients experienced vascular graft complications or small-for-size graft dysfunction. There were no significant differences in the incidence of posttransplant complications between the donors and recipients of the PS and RL groups. The 3-year graft survival rates were favorable in both groups (100% in the PS group versus 91% in the RL group). In conclusion, the selection of RPS grafts by volume criteria is a feasible strategy for an adult-to-adult LDLT program.
为了确定容积标准在成人对成人活体肝移植（LDLT）中选择右后叶（RPS）移植物的可行性，我们回顾并比较了我们的 RPS 移植物和右叶（RL）移植物的移植数据。2008 年 1 月至 2010 年 9 月，我们所在的研究所共进行了 65 例成人对成人 LDLT；其中 13 例（20%）采用 RPS 移植物进行（PS 组），39 例（60%）采用 RL 移植物进行（RL 组）。13 例 RPS 供肝的体积测量结果显示，RPS 体积占总肝体积的 39.8%±7.6%。13 例供者中有 10 例因左肝体积不足而不得不捐献 RPS 移植物。所有供者手术均成功完成，且均从肝切除术中恢复。然而，与 RL 移植物相比，RPS 移植物的获取时间更长（418±40 分钟与 345±48 分钟，P<0.001）。与 RL 组相比，PS 组供者的肝功能恢复更平稳。RPS 移植物的肝动脉和胆管开口明显小于 RL 移植物。所有接受 RPS 移植物的受者均存活 LDLT。受者未发生血管移植物并发症或小肝综合征。PS 和 RL 组供受者的移植后并发症发生率无显著差异。两组 3 年移植物存活率均较好（PS 组 100%，RL 组 91%）。总之，根据体积标准选择 RPS 移植物是成人对成人 LDLT 方案的一种可行策略。
