Bekheit Mohamed, Rajakannu Muthukumarassamy, Bucur Petru, Adam Rene, SaCunha Antonio, Castaing Denis, Cherqui Daniel, Vibert Eric
Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France; INSERM, Unit 1193, Villejuif, France.
Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France; University of Paris-Sud, Villejuif, France; INSERM, Unit UMRS776, Villejuif, F-94800, France.
HPB (Oxford). 2016 Feb;18(2):200-206. doi: 10.1016/j.hpb.2015.08.006. Epub 2015 Nov 28.
After whole graft orthotopic liver transplantation (OLT), adaptation of the large grafts' volume to recipient weight is widely accepted despite the paucity of evidence on this subject.
Thirty nine patients with GRWR > 2.5% were included in this study and subsequently divided into two groups with 3 ≥ GRWR > 3%. Patients had CT scans at three predetermined time points after OLT used for measuring the liver volume. The objective of this study is to evaluate the volumetric changes of whole large liver grafts after adult OLT.
At LT, the mean graft recipient body weight ratio (GRWR) was 3.1 ± 0.4%. The mean liver weight was 1881 ± 68 g at LT, 2014 ± 99 ml at one week, 1725 ± 126 ml at 3 months, and 1632 ± 117 (ml) at >6 months. There is an initial increase at 1 week after LT and a subsequent decrease of liver volume on later measurements. None of the late volume measurements were significantly different from the initial graft volume at liver transplant in pair wise comparisons ANOVA repeated measures (p > 0.05). Similarly, the mean GRWR did not change significantly between the initial calculation at transplantation date and the subsequent measurements during the different study time points (F = 0.04, p = 0.96) with a mean of 3.1% (95% CI = 2.2-4.2). AUC ROC discriminated a cutoff of 3% for the initial GRWR above which grafts tend to decrease in size over time (c statistics = 0.74, p = 0.036). In a Clustered ANOVA repeated measures, there was no significant difference in the changes of liver volume between both groups. However, patients with GRWR > 3 showed a trend towards a latent reduction in volume over the tracing period. There was a tendency, but none significant; towards a higher bilirubin, AST, ALT levels over the first postoperative days in recipients with GRWR > 3.
Large grafts do not significantly decrease in size. Nonetheless, grafts weighing >3% of the GRWR show a different trend towards decrease in size over time.
在全肝原位肝移植（OLT）后，尽管关于这一主题的证据匮乏，但使大体积移植物的体积适应受体体重已被广泛接受。
本研究纳入了39例移植肝重量与受体体重比（GRWR）>2.5%的患者，随后将其分为两组，其中3例患者的GRWR≥3%。患者在OLT后的三个预定时间点进行CT扫描，以测量肝脏体积。本研究的目的是评估成人OLT后全肝大移植物的体积变化。
肝移植时，平均移植肝与受体体重比（GRWR）为3.1±0.4%。肝移植时平均肝脏重量为1881±68g，术后1周为2014±99ml，3个月时为1725±126ml，6个月以上时为1632±117（ml）。肝移植后1周肝脏体积最初增加，随后的测量显示肝脏体积减小。在重复测量方差分析的两两比较中，后期的体积测量值与肝移植时的初始移植物体积均无显著差异（p>0.05）。同样，移植日期的初始计算值与不同研究时间点的后续测量值之间，平均GRWR无显著变化（F = 0.04，p = 0.96），平均值为3.1%（95%CI = 2.2 - 4.2）。AUC ROC鉴别出初始GRWR的临界值为3%，高于该值移植物大小往往会随时间减小（c统计量 = 0.74，p = 0.036）。在重复测量的聚类方差分析中，两组之间肝脏体积变化无显著差异。然而，GRWR>3的患者在追踪期内显示出体积潜在减小的趋势。GRWR>3的受体在术后最初几天有胆红素、AST、ALT水平升高的趋势，但无显著差异。
大体积移植物大小无显著减小。尽管如此，重量>GRWR 3%的移植物随时间推移显示出不同的体积减小趋势。
