Marubashi Shigeru, Nagano Hiroaki, Eguchi Hidetoshi, Wada Hiroshi, Asaoka Tadafumi, Tomimaru Yoshito, Tomokuni Akira, Umeshita Koji, Doki Yuichiro, Mori Masaki
Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Liver Transpl. 2016 May;22(5):599-606. doi: 10.1002/lt.24388.
Small-for-size graft syndrome is an inevitable complication in living donor liver transplantation (LDLT). We hypothesized that graft weight (GW) measured after graft procurement is one of the variables predicting postoperative graft function. A total of 138 consecutive recipients of adult-to-adult LDLT between March 1999 and October 2014 were included in this study. We investigated the factors associated with small-for-size-associated graft loss (SAGL) to determine the GW required for each patient. Both preoperatively assessed and postoperatively obtained risk factors for SAGL were analyzed in univariate and multivariate logistic regression analysis. Twelve (8.8%) of the transplant recipients had SAGL. In multivariate logistic regression analyses using preoperatively assessed variables, the preoperative Model for End-Stage Liver Disease (MELD) score (P < 0.001) and actual GW/recipient standard liver volume (SLV) ratio (P = 0.008) were independent predictors of SAGL. The recommended graft volume by preoperative computed tomography volumetry was calculated as SLV × (1.616 × MELD + 0.344)/100/0.85 (mL) [MELD ≥ 18.2], or SLV × 0.35 (mL) [MELD < 18.2]. The required allograft volume in LDLT can be determined by the preoperative MELD score of the recipient, and patients with higher MELD scores require larger grafts or deceased donor whole liver transplant to avoid SAGL. Liver Transplantation 22 599-606 2016 AASLD.
小体积移植物综合征是活体肝移植（LDLT）中不可避免的并发症。我们推测，获取移植物后测量的移植物重量（GW）是预测术后移植物功能的变量之一。本研究纳入了1999年3月至2014年10月期间连续接受成人对成人LDLT的138例受者。我们调查了与小体积相关移植物丢失（SAGL）相关的因素，以确定每位患者所需的GW。对术前评估和术后获得的SAGL危险因素进行单因素和多因素逻辑回归分析。12例（8.8%）移植受者发生SAGL。在使用术前评估变量的多因素逻辑回归分析中，术前终末期肝病模型（MELD）评分（P < 0.001）和实际GW/受者标准肝体积（SLV）比值（P = 0.008）是SAGL的独立预测因素。术前计算机断层扫描体积测量法推荐的移植物体积计算为SLV×(1.616×MELD + 0.344)/100/0.85（mL）[MELD≥18.2]，或SLV×0.35（mL）[MELD < 18.2]。LDLT中所需的同种异体移植物体积可根据受者术前MELD评分确定，MELD评分较高的患者需要更大的移植物或尸体供体全肝移植以避免SAGL。《肝脏移植》22 599 - 606 2016美国肝脏病研究协会
