Department of Hepatobiliary Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Liver Transpl. 2012 Mar;18(3):305-14. doi: 10.1002/lt.22440.
Recently, the successful application of portal inflow modulation has led to renewed interest in the use of left lobe grafts in adult-to-adult living donor liver transplantation (LDLT). However, data on the hepatic hemodynamics supporting portal inflow modulation are limited, and the optimal portal circulation for a liver graft is still unclear. We analyzed 42 consecutive adult-to-adult left lobe LDLT cases without splenectomy or a portocaval shunt. The mean actual graft volume (GV)/recipient standard liver volume (SLV) ratio was 39.8% ± 5.7% (median = 38.9%, range = 26.1%-54.0%). The actual GV/SLV ratio was less than 40% in 24 of the 42 cases, and the actual graft-to-recipient weight ratio was less than 0.8% in 17 of the 42 recipients. The mean portal vein pressure (PVP) was 23.9 ± 7.6 mm Hg (median = 23.5 mm Hg, range = 9-38 mm Hg) before transplantation and 21.5 ± 3.6 mm Hg (median = 22 mm Hg, range = 14-27 mm Hg) after graft implantation. The mean portal pressure gradient (PVP - central venous pressure) was 14.5 ± 6.8 mm Hg (median = 13.5 mm Hg, range = 3-26 mm Hg) before transplantation and 12.4 ± 4.4 mm Hg (median = 13 mm Hg, range = 1-21 mm Hg) after graft implantation. The mean posttransplant portal vein flow was 301 ± 167 mL/minute/100 g of liver in the 38 recipients for whom it was measured. None of the recipients developed small-for-size syndrome, and all were discharged from the hospital despite portal hyperperfusion. The overall 1-, 3-, and 5-year patient and graft survival rates were 100%, 97%, and 91%, respectively. In conclusion, LDLT with a left liver graft without splenectomy or a portocaval shunt yields good long-term results for adult patients with a minimal donor burden.
最近，门静脉流入调节的成功应用再次引起了人们对成人活体肝移植（LDLT）中使用左叶移植物的兴趣。然而，关于支持门静脉流入调节的肝血流动力学的数据有限，并且对于肝移植物来说，最佳的门脉循环仍然不清楚。我们分析了 42 例连续的成人对成人左叶 LDLT 病例，这些病例均未行脾切除术或门腔分流术。平均实际移植物体积（GV）/受体标准肝体积（SLV）比为 39.8%±5.7%（中位数=38.9%，范围=26.1%-54.0%）。42 例中有 24 例实际 GV/SLV 比小于 40%，42 例受体中有 17 例实际移植物与受体的重量比小于 0.8%。移植前门静脉压力（PVP）平均为 23.9±7.6mmHg（中位数=23.5mmHg，范围=9-38mmHg），移植后 PVP 为 21.5±3.6mmHg（中位数=22mmHg，范围=14-27mmHg）。移植前门静脉压力梯度（PVP-中心静脉压）平均为 14.5±6.8mmHg（中位数=13.5mmHg，范围=3-26mmHg），移植后为 12.4±4.4mmHg（中位数=13mmHg，范围=1-21mmHg）。在 38 例可测量门静脉流速的受体中，平均移植后门静脉流量为 301±167mL/min/100g 肝脏。所有受体均未发生小肝综合征，尽管门脉高灌注，所有受体均出院。总体 1 年、3 年和 5 年患者和移植物存活率分别为 100%、97%和 91%。总之，对于成人患者，不进行脾切除术或门腔分流术的左肝叶移植物 LDLT 可带来良好的长期效果，且供体负担最小。
