Department of Liver and Vascular Surgery, Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
PLoS One. 2013 Sep 11;8(9):e74081. doi: 10.1371/journal.pone.0074081. eCollection 2013.
To evaluate the impact of small-for-size grafts (SFSG) in adult-to-adult living donor liver transplantation (AALDLT) on outcomes of recipients with different model for end-stage liver disease (MELD) score in a single liver transplant center.
Clinical data of 118 patients underwent right-lobe AALDLT from January 2004 to December 2011 were retrospectively analyzed, Patients were divided into Group L (MELD score ≤ 25) and Group H (MELD score > 25) according to MELD score. The patients were further stratified into Group LS (MELD score ≤ 25, GBWR < 0.8%), Group LN (MELD score ≤ 25, GBWR ≥ 0.8%), Group HS (MELD score > 25, GBWR < 0.8%), and Group HN (MELD score > 25, GBWR ≥ 0.8%) to investigate the impact of graft size on recipients' complications and outcomes. Pre-operative characteristics, post-operative complications graded by the Clavien score and patient survival were analyzed.
MELD scores between the two groups were significant different (12.4 ± 4.9 vs 34.5 ± 7.5, P = 0.026). There was no significant difference in preoperative demographic data as well as postoperative liver function. Complication rate, length of ICU and hospital stay, graft loss, and mortality were similar in both groups. The 1- and 3- year survival were similar between group H and group L. When recipients were further stratified into group LS, LN, HS, and HN, no significant difference was found among groups in 1- and 3- year survival rate. In multivariate analysis, HCC was not a predictor for long term survival.
Our single institution experience demonstrates that it is safe to use SFSGs in high pre-MELD score recipients with the improvement of intensive care and the selection of listing criteria.
评估小体积供肝（SFSG）在成人对成人活体肝移植（AALDLT）中对不同终末期肝病模型（MELD）评分受体结局的影响，该研究在一个单一的肝移植中心进行。
回顾性分析 2004 年 1 月至 2011 年 12 月期间 118 例接受右半肝 AALDLT 的患者的临床资料。根据 MELD 评分将患者分为 L 组（MELD 评分≤25）和 H 组（MELD 评分＞25）。进一步将患者分为 LS 组（MELD 评分≤25，GBWR＜0.8%）、LN 组（MELD 评分≤25，GBWR≥0.8%）、HS 组（MELD 评分＞25，GBWR＜0.8%）和 HN 组（MELD 评分＞25，GBWR≥0.8%），以研究供肝体积对受体并发症和结局的影响。分析术前特征、Clavien 分级术后并发症和患者生存率。
两组患者的 MELD 评分差异有统计学意义（12.4±4.9 比 34.5±7.5，P=0.026）。两组患者的术前人口统计学数据和术后肝功能无显著差异。两组患者的并发症发生率、ICU 和住院时间、移植物丢失和死亡率相似。H 组和 L 组的 1 年和 3 年生存率相似。当受体进一步分为 LS、LN、HS 和 HN 组时，各组 1 年和 3 年生存率无显著差异。多因素分析显示，HCC 不是长期生存的预测因素。
本研究表明，在加强重症监护和选择适应证的情况下，使用小体积供肝对高 MELD 评分受体是安全的。
