Pei-Xian Chen, Lu-Nan Yan, Wen-Tao Wang, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2014 Jan 7;20(1):282-9. doi: 10.3748/wjg.v20.i1.282.
To investigate the outcome of living donor liver transplantation (LDLT) recipients transplanted with small-for-size grafts (SFSGs).
Between November 2001 and December 2010, 196 patients underwent LDLT with right lobe liver grafts at our center. Recipients were divided into 2 treatment groups: group A with an actuarial graft-to-recipient weight ratio (aGRWR) < 0.8% (n = 45) and group B with an aGRWR ≥ 0.8% (n = 151). We evaluated serum liver function markers within 4 wk after transplantation. We also retrospectively evaluated the outcomes of these patients for potential effects related to the recipients, the donors and the transplantation procedures based upon a review of their medical records.
Small-for-size syndrome (SFSS) developed in 7 of 45 patients (15.56%) in group A and 9 of 151 patients (5.96%) in group B (P = 0.080). The levels of alanine aminotransferase and aspartate aminotransferase in group A were higher than those in group B during early period after transplantation, albeit not significantly. The cumulative 1-, 3- and 5-year liver graft survival rates were 82.22%, 71.11% and 71.11% for group A and 81.46%, 76.82%, and 75.50% for group B patients, respectively (P = 0.623). However, univariate analysis of risk factors associated with graft survival in group A demonstrated that the occurrence of SFSS after LDLT was the only significant risk factor affecting graft survival (P < 0.001). Furthermore, multivariate analysis of our data did not identify any additional significant risk factors accounting for poor graft survival.
Our study suggests that LDLT recipients with an aGRWR < 0.8% may have liver graft outcomes comparable to those who received larger size grafts. Further studies are required to ascertain the safety of using SFSGs.
研究小体积供肝肝移植（LDLT）受者的预后。
2001 年 11 月至 2010 年 12 月，我们中心对 196 例患者进行了右半肝 LDLT。将受者分为 2 个治疗组：A 组为计算的移植物与受体重量比（aGRWR）<0.8%（n=45），B 组为 aGRWR≥0.8%（n=151）。我们在移植后 4 周内评估血清肝功能标志物。我们还回顾性评估了这些患者的结果，根据他们的病历，评估与受者、供者和移植程序相关的潜在影响。
A 组中 7 例（15.56%）和 B 组中 9 例（5.96%）患者发生小肝综合征（SFSS）（P=0.080）。尽管差异无统计学意义，但 A 组患者在移植后早期的丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平高于 B 组。A 组患者的累积 1、3 和 5 年肝移植物存活率分别为 82.22%、71.11%和 71.11%，B 组分别为 81.46%、76.82%和 75.50%（P=0.623）。然而，A 组移植物存活率相关风险因素的单因素分析显示，LDLT 后发生 SFSS 是影响移植物存活率的唯一显著危险因素（P<0.001）。此外，我们数据的多因素分析没有发现任何其他导致移植物存活率较差的显著危险因素。
我们的研究表明，aGRWR<0.8%的 LDLT 受者的肝移植物预后可能与接受较大体积移植物的受者相当。需要进一步的研究来确定使用小体积供肝的安全性。
