Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY 10029, USA.
Surgery. 2013 May;153(5):619-26. doi: 10.1016/j.surg.2012.11.020. Epub 2013 Feb 13.
Extensive attention has been placed on remnant liver volume (RLV) above other factors to ensure donor safety.
We performed a retrospective review of 137 right hepatectomies in live donors between June 1999 and November 2010.
Median right lobe volume was 1,029 cm(3), which correlated with its actual weight (r = 0.63, P < .01); median RLV was 548 cm(3). Of the donors, 32 (24%) developed postoperative hepatic dysfunction (bilirubin >3 mg/dL or prothrombin time >18 s on postoperative day 4). RLV did not predict postoperative hepatic dysfunction (P = .9), but it was associated with peak international normalized ratio (INR) (P = .04). Donor age and male gender were predictors of increased bilirubin at postoperative day 4 (age, P = .03; gender, P = .02). Of the donors, 45 (33%) experienced complications, and 24 donors had RLVs <30%; 42% experienced complications compared to 31% of donors whose RLVs were greater than 30% (P = .3). Cell-saver utilization and aspartate-aminotransferase (AST) levels (OR = 3) were associated with complications. Volumetric assessment can predict RLV accurately.
Although no demonstrable association between RLV <30% and complications was found, an RLV of 30% should remain the threshold for donor safety. Age and gender should be balanced in donors with a near threshold RLV of 30%. Surgical complexity, suggested by the need for intraoperative autoinfusion of blood and postoperative levels of AST, remained the independent predictor of complications.
为确保供者安全,人们广泛关注残肝体积(RLV)以外的其他因素。
我们对 1999 年 6 月至 2010 年 11 月期间 137 例活体右半肝供者的资料进行了回顾性分析。
右肝体积中位数为 1029cm³,与实际重量呈正相关(r=0.63,P<.01);RLV 中位数为 548cm³。32 例(24%)供者术后出现肝功能不全(术后第 4 天胆红素>3mg/dL 或凝血酶原时间>18s)。RLV 与术后肝功能不全无相关性(P=0.9),但与峰值国际标准化比值(INR)相关(P=0.04)。供者年龄和性别是术后第 4 天胆红素升高的预测因素(年龄,P=0.03;性别,P=0.02)。45 例(33%)供者发生并发症,24 例 RLV<30%;与 RLV>30%的供者(42%)相比,30%的供者并发症发生率为 31%(P=0.3)。使用血液回收机和天冬氨酸转氨酶(AST)水平(OR=3)与并发症相关。体积评估可准确预测 RLV。
尽管未发现 RLV<30%与并发症之间存在明显相关性,但 30%的 RLV 仍应作为供者安全的阈值。对于 RLV 接近 30%的供者,应平衡年龄和性别。手术复杂性,即术中需要自体输血和术后 AST 水平,仍然是并发症的独立预测因素。