Chen Peixian, Wang Wentao, Yan Lunan
Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China (mainland).
Ann Transplant. 2014 Jan 13;19:13-22. doi: 10.12659/AOT.889735.
Right lobar living donor living transplantation (LDLT) has been controversial because of widely differing reports of recipient morbidity. Herein, we present our nearly 10-year experience and identify factors that potentially could be modified to improve recipient outcome.
MATERIAL/METHODS: The Clavien 5-tier grading system was applied retrospectively in 196 consecutive adult right lobar recipients. We determined the incidence of potentially life- threatening (Grade III), actually life-threatening (Grade IV), and lethal (Grade V) complications during the first post-transplant year. The most serious and seminal complication was considered if simultaneous or multiple complications appeared.
One-year recipient/graft survival was 82%/82%. Within the first year, 68 (34.69%) of the 196 recipients had Grade III (n=31), Grade IV (n=7), or Grade V (n=30) complications. The complications were 19.90% graft-related and 15.82% non-graft-related. Complications during the first half year did not decline with increased team experience over time and adversely affected recipients' long-term survival, albeit not significantly. According to univariate analysis, high Child-Pugh scores before transplantation (P=0.016), prolonged ICU-stay (P=0.003) and hospitalization time (P=0.032) after transplantation were found to be risk factors for the appearance of ≥ Clavien III complications, while duct-to-duct biliary reconstruction (P=0.02) had a beneficial role in reducing serious complications after LDLTs.
In conclusion, serious complications during the first post-transplant year shortened recipient survival and prolonged primary hospitalization duration and postoperative ICU-stay, which is more frequent in recipients with higher Child-Pugh scores and in those with hepaticojejunostomy.
右叶活体供体肝移植（LDLT）一直存在争议，因为关于受体发病率的报道差异很大。在此，我们介绍我们近10年的经验，并确定可能可以改变的因素以改善受体结局。
材料/方法：对196例连续的成年右叶受体进行回顾性应用Clavien 5级分级系统。我们确定了移植后第一年潜在危及生命（III级）、实际危及生命（IV级）和致命（V级）并发症的发生率。如果出现同时或多种并发症，则考虑最严重和最关键的并发症。
受体/移植物1年生存率为82%/82%。在第一年，196例受体中有68例（34.69%）发生III级（n = 31）、IV级（n = 7）或V级（n = 30）并发症。并发症与移植物相关的占19.90%，与非移植物相关的占15.82%。上半年的并发症并未随着团队经验的增加而随时间下降，并且对受体的长期生存产生不利影响，尽管影响不显著。单因素分析显示，移植前Child-Pugh评分高（P = 0.016）、移植后ICU停留时间延长（P = 0.003）和住院时间延长（P = 0.032）是出现≥Clavien III级并发症的危险因素，而胆管对胆管的胆道重建（P = 0.02）在降低LDLT术后严重并发症方面具有有益作用。
总之，移植后第一年的严重并发症缩短了受体生存时间，延长了初次住院时间和术后ICU停留时间，在Child-Pugh评分较高的受体和接受肝空肠吻合术的受体中更常见。
