Yamada Naoya, Sanada Yukihiro, Hirata Yuta, Okada Noriki, Wakiya Taiichi, Ihara Yoshiyuki, Miki Atsushi, Kaneda Yuji, Sasanuma Hideki, Urahashi Taizen, Sakuma Yasunaru, Yasuda Yoshikazu, Mizuta Koichi
Department of Transplant Surgery, Tochigi, Japan.
Liver Transpl. 2015 Feb;21(2):233-8. doi: 10.1002/lt.24048. Epub 2015 Jan 12.
In the field of pediatric living donor liver transplantation (LDLT), physicians sometimes must reduce the volume of left lateral segment (LLS) grafts to prevent large-for-size syndrome. There are 2 established methods for decreasing the size of an LLS graft: the use of a segment 2 (S2) monosegment graft and the use of a reduced LLS graft. However, no procedure for selecting the proper graft type has been established. In this study, we conducted a retrospective investigation of LDLT and examined the strategy of graft selection for patients weighing ≤6 kg. LDLT was conducted 225 times between May 2001 and December 2012, and 15 of the procedures were performed in patients weighing ≤6 kg. We selected S2 monosegment grafts and reduced LLS grafts if the preoperative computed tomography (CT)-volumetry value of the LLS graft was >5% and 4% to 5% of the graft/recipient weight ratio, respectively. We used LLS grafts in 7 recipients, S2 monosegment grafts in 4 recipients, reduced S2 monosegment grafts in 3 recipients, and a reduced LLS graft in 1 recipient. The reduction rate of S2 monosegment grafts for use as LLS grafts was 48.3%. The overall recipient and graft survival rates were both 93.3%, and 1 patient died of a brain hemorrhage. Major surgical complications included hepatic artery thrombosis in 2 recipients, bilioenteric anastomotic strictures in 2 recipients, and portal vein thrombosis in 1 recipient. In conclusion, our graft selection strategy based on preoperative CT-volumetry is highly useful in patients weighing ≤6 kg. S2 monosegment grafts are effective and safe in very small infants particularly neonates.
在小儿活体肝移植（LDLT）领域，医生有时必须减小左外叶（LLS）移植物的体积以预防大体积综合征。目前有两种既定的减小LLS移植物尺寸的方法：使用第2段（S2）单段移植物和使用缩小的LLS移植物。然而，尚未确立选择合适移植物类型的程序。在本研究中，我们对LDLT进行了回顾性调查，并研究了体重≤6 kg患者的移植物选择策略。2001年5月至2012年12月期间共进行了225例LDLT手术，其中15例手术的患者体重≤6 kg。如果LLS移植物的术前计算机断层扫描（CT）体积测量值分别>移植物/受者体重比的5%和4%至5%，我们分别选择S2单段移植物和缩小的LLS移植物。我们对7例受者使用了LLS移植物，4例受者使用了S2单段移植物，3例受者使用了缩小的S2单段移植物，1例受者使用了缩小的LLS移植物。用作LLS移植物的S2单段移植物的缩小率为48.3%。受者和移植物的总体生存率均为93.3%，1例患者死于脑出血。主要手术并发症包括2例受者发生肝动脉血栓形成，2例受者发生胆肠吻合口狭窄，1例受者发生门静脉血栓形成。总之，我们基于术前CT体积测量的移植物选择策略对体重≤6 kg的患者非常有用。S2单段移植物在非常小的婴儿尤其是新生儿中有效且安全。
