Department of Hepatobiliary, Pancreas and Transplant Surgery, Kyoto University, Kyoto, Japan.
Am J Transplant. 2012 Dec;12(12):3406-13. doi: 10.1111/j.1600-6143.2012.04268.x. Epub 2012 Sep 20.
Few studies have examined the long-term outcomes and prognostic factors associated with pediatric living living-donor liver transplantation (LDLT) using reduced and hyper-reduced left lateral segment grafts. We conducted a retrospective, single-center assessment of the outcomes of this procedure, as well as clinical factors that influenced graft and patient survival. Between September 2000 and December 2009, 49 patients (median age: 7 months, weight: 5.45 kg) underwent LDLT using reduced (partial left lateral segment; n = 5, monosegment; n = 26), or hyper-reduced (reduced monosegment grafts; n = 18) left lateral segment grafts. In all cases, the estimated graft-to-recipient body weight ratio of the left lateral segment was more than 4%, as assessed by preoperative computed tomography volumetry, and therefore further reduction was required. A hepatic artery thrombosis occurred in two patients (4.1%). Portal venous complications occurred in eight patients (16.3%). The overall patient survival rate at 1, 3 and 10 years after LDLT were 83.7%, 81.4% and 78.9%, respectively. Multivariate analysis revealed that recipient age of less than 2 months and warm ischemic time of more than 40 min affected patient survival. Pediatric LDLT using reduced and hyper-reduced left lateral segment grafts appears to be a feasible option with acceptable graft survival and vascular complication rates.
鲜有研究探讨使用缩小和超缩小左外叶供肝的小儿活体肝移植（LDLT）的长期结果和预后因素。我们对该手术的结果以及影响移植物和患者生存的临床因素进行了回顾性、单中心评估。2000 年 9 月至 2009 年 12 月，49 名患者（中位年龄：7 个月，体重：5.45kg）接受了使用缩小（部分左外叶；n=5，单叶段；n=26）或超缩小（缩小的单叶段供肝；n=18）左外叶供肝的 LDLT。所有患者术前 CT 体积测量评估的左外叶供肝与受者体重比均超过 4%，因此需要进一步缩小。2 例（4.1%）发生肝动脉血栓形成。8 例（16.3%）发生门静脉并发症。LDLT 后 1、3 和 10 年的患者总生存率分别为 83.7%、81.4%和 78.9%。多因素分析显示，受体年龄小于 2 个月和热缺血时间超过 40min 影响患者生存率。使用缩小和超缩小左外叶供肝的小儿 LDLT 似乎是一种可行的选择，具有可接受的移植物存活率和血管并发症发生率。
