Yoshizumi Tomoharu, Ikegami Toru, Kimura Koichi, Uchiyama Hideaki, Ikeda Tetsuo, Shirabe Ken, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Liver Transpl. 2014 Sep;20(9):1089-96. doi: 10.1002/lt.23924. Epub 2014 Aug 4.
Right posterior sector (RPS) grafts have been used to overcome graft size discrepancies, the major concern of living donor liver transplantation. Previous studies have reported the volumetry-based selection of RPS grafts without anatomical exclusion. We reviewed our data and established selection criteria for RPS grafts. The procurement of RPS grafts [conventional (n = 3) and extended (n = 5)] was performed for 8 of 429 recipients at our center. Extended RPS grafts contained the drainage area of the right hepatic vein. The mean graft weight (GW) according to 3-dimensional computed tomography volumetry was 488 g, and the GW/standard liver weight (SLW) ratio was 42.6%. The mean actual GW was 437 g, and the GW/SLW ratio was 38.4%. One donor exhibited standard bifurcation of the right portal vein (PV) and the left PV, and 2 donors exhibited trifurcation of the left PV, the right anterior portal vein (APV), and the posterior PV. The remaining 5 donors exhibited APV branching from the left PV, which is the most suitable anatomy for RPS grafts. Two recipients died of sepsis or small-for-size graft syndrome. One underwent retransplantation because of an intractable bile leak and fibrosing cholestatic hepatitis. Intractable bile duct (BD) stenosis developed in 4 of the 6 survivors. In conclusion, with the significant complications and potential concerns associated with RPS grafts, these grafts should be used very rarely and with extreme caution. Donors with the standard bifurcation of the PV and the posterior BD running through the dorsal side of the posterior PV are not suitable candidates for RPS grafts. Extended RPS graft procurement is recommended for easier parenchymal transection.
右后叶（RPS）移植物已被用于克服移植物大小差异，这是活体供肝移植的主要关注点。先前的研究报道了基于体积测量法选择RPS移植物且无解剖学排除标准。我们回顾了我们的数据并制定了RPS移植物的选择标准。我们中心为429例受者中的8例获取了RPS移植物[传统型（n = 3）和扩展型（n = 5）]。扩展型RPS移植物包含右肝静脉的引流区域。根据三维计算机断层扫描体积测量法，平均移植物重量（GW）为488 g，GW/标准肝脏重量（SLW）比值为42.6%。平均实际GW为437 g，GW/SLW比值为38.4%。1例供者表现为右门静脉（PV）和左PV标准分叉，2例供者表现为左PV、右前门静脉（APV）和后PV三叉。其余5例供者表现为APV从左PV分支，这是RPS移植物最合适的解剖结构。2例受者死于脓毒症或小体积移植物综合征。1例因顽固性胆漏和纤维性胆汁淤积性肝炎接受了再次移植。6例幸存者中有4例发生了顽固性胆管（BD）狭窄。总之，鉴于RPS移植物存在显著并发症和潜在问题，应极少且极其谨慎地使用这些移植物。PV标准分叉且后BD穿过后PV背侧的供者不是RPS移植物的合适候选者。建议采用扩展型RPS移植物获取法以便于肝实质离断。
