Fong Yuen Ki, Chan See Ching, Cheung Tan To, Dai Wing Chiu, Chok Kenneth S H, Chan Albert C Y, Sharr William W, Lo Chung Mau
Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
Hepatol Int. 2013 Jun;7(2):734-40. doi: 10.1007/s12072-012-9410-3. Epub 2012 Nov 14.
Living donor liver transplantation is a realistic life-saving treatment in regions where deceased donor organs are scarce. The minimum remnant left liver volume (RLLV) requirement for donor right hepatectomy (DRH) varies in different programs of living donor liver transplantation. The present study aimed to determine how significant the RLLV is in the recovery of right liver donors.
A total of 349 consecutive donors who underwent DRH including the middle hepatic vein were divided into nine groups according to the percentage of the RLLV. The peak and recovery of the serum bilirubin level and prothrombin time (PT) in the 1st week after operation and postoperative complications were studied.
The median RLLV was 35.5 (27-49.5) %. Postoperative peak serum bilirubin was highest [74 (25-133) μmol/L] in the group with RLLVs <30 %. This group also had the highest peak PT [18.9 (15.4-24.4) s], although results were similar between groups. Total bilirubin peaked on postoperative days 1-2 in groups with RLLVs ≥35 %. In groups with RLLVs <35 %, total bilirubin peaked on day 3. PT took 1-2 days to peak and nearly approached preoperative values on day 7 in all groups. Complication rates ranged from 0 to 75 %. The rates of complications of Clavien-Dindo grade 3 or above ranged from 0 to 3.8 %. Postoperative peak bilirubin was associated with severe complications (p = 0.031). Age, postoperative peak PT, and RLLV were independent risk factors for prolonged hospital stay.
There was a demonstrable trend of slower recovery of liver function in donors with smaller RLLVs.
在已故供体器官稀缺的地区，活体供肝移植是一种切实可行的挽救生命的治疗方法。不同的活体供肝移植项目中，供体右半肝切除术（DRH）对剩余左肝最小体积（RLLV）的要求各不相同。本研究旨在确定RLLV对右半肝供体恢复的重要性。
总共349例接受包括肝中静脉的DRH的连续供体，根据RLLV的百分比分为九组。研究术后第1周血清胆红素水平和凝血酶原时间（PT）的峰值及恢复情况以及术后并发症。
RLLV的中位数为35.5（27 - 49.5）%。RLLV < 30%的组术后血清胆红素峰值最高[74（25 - 133）μmol/L]。该组PT峰值也最高[18.9（15.4 - 24.4）秒]，不过各组结果相似。RLLV≥35%的组总胆红素在术后1 - 2天达到峰值。RLLV < 35%的组总胆红素在第3天达到峰值。所有组PT在1 - 2天达到峰值，第7天几乎接近术前值。并发症发生率在0至75%之间。Clavien - Dindo 3级及以上并发症的发生率在0至3.8%之间。术后胆红素峰值与严重并发症相关（p = 0.031）。年龄、术后PT峰值和RLLV是住院时间延长的独立危险因素。
RLLV较小的供体肝功能恢复明显有更慢的趋势。
