Department of Surgery, University of Hong Kong, Hong Kong, China.
Liver Transpl. 2012 Sep;18(9):1078-82. doi: 10.1002/lt.23433.
In living donor liver transplantation (LDLT), a right liver graft is larger than a left liver graft and hence leads to better recipient survival. However, in comparison with donor left hepatectomy, donor right hepatectomy carries a higher donor risk. We estimated the expansion of the applicability of left liver living donor liver transplantation (LLDLT) by lowering the graft weight (GW)/standard liver volume (SLV) ratio in increments of 5%. Consecutive LDLT cases were included in this study. The results of computed tomography volumetry provided the graft volume measurements, and the GW was derived from the graft volume with the conversion factor of 1.19 mL/g. We tried to estimate how many more times LLDLT would have been feasible if the GW/SLV requirement had been lowered to 40%, 35%, 30%, or 25%. In all, 361 consecutive donor-recipient pairs underwent LDLT. Right liver living donor liver transplantation (RLDLT) accounted for 95% of the LDLT cases. Most recipients were male (74.2%), and most donors were female (60.4%). The median GW/SLV ratio was 46% (47% for RLDLT and 37% for LLDLT, P < 0.001). Two of the 218 female donors donated the left liver, and 12 of the 93 female recipients received a left liver. In 147 of the 173 cases (85%) when the donor was female and the recipient was male, the GW/SLV ratio did not reach 30%. LLDLT could have been performed more often than 5% of the time if a lower GW/SLV requirement had been adopted. With GW/SLV ratios ≥ 40%, ≥ 35%, ≥ 30%, and ≥ 25%, the proportion of LLDLT cases would have risen from 5% to 5.8%, 12.5%, 29.1%, and 62.3%, respectively. LLDLT could have been performed approximately twice as often with every 5% reduction of the GW/SLV requirement. In conclusion, lowering the graft size requirement could improve the applicability of LLDLT and hence reduce donor risk.
在活体肝移植（LDLT）中，右肝移植物比左肝移植物大，因此能提高受体的存活率。然而，与供体左肝切除术相比，供体右肝切除术的供体风险更高。我们通过降低肝移植供体重量（GW）/标准肝体积（SLV）比值（每次降低 5%）来评估扩大左半肝活体肝移植（LLDLT）的适用性。本研究纳入了连续的 LDLT 病例。计算机断层扫描体积测量提供了移植物体积测量值，GW 由移植物体积乘以转换系数 1.19 mL/g 得出。我们试图估计，如果 GW/SLV 要求降低到 40%、35%、30%或 25%，LLDLT 会增加多少倍的可行性。共有 361 对连续的供体-受者接受了 LDLT。右半肝活体肝移植（RLDLT）占 LDLT 病例的 95%。大多数受者为男性（74.2%），大多数供者为女性（60.4%）。中位 GW/SLV 比值为 46%（RLDLT 为 47%，LLDLT 为 37%，P<0.001）。218 名女性供者中有 2 名捐献了左半肝，93 名女性受者中有 12 名接受了左半肝。在 173 例供者为女性、受者为男性的病例中，147 例（85%）的 GW/SLV 比值未达到 30%。如果采用较低的 GW/SLV 要求，LLDLT 的实施频率可能会增加 5%以上。当 GW/SLV 比值≥40%、≥35%、≥30%和≥25%时，LLDLT 病例的比例将分别从 5%上升至 5.8%、12.5%、29.1%和 62.3%。GW/SLV 比值每降低 5%，LLDLT 的实施频率可能增加近两倍。总之，降低移植物大小的要求可以提高 LLDLT 的适用性，从而降低供体风险。
