Kurihara Takeshi, Yoshizumi Tomoharu, Yoshida Yoshihiro, Ikegami Toru, Itoh Shinji, Harimoto Norifumi, Ninomiya Mizuki, Uchiyama Hideaki, Okabe Hirohisa, Kimura Koichi, Kawanaka Hirofumi, Shirabe Ken, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Clinical Research Institute, Beppu Medical Center, Beppu, Japan.
Liver Transpl. 2016 Jul;22(7):914-22. doi: 10.1002/lt.24431.
To ensure donor safety in living donor liver transplantation (LDLT), the left and caudate lobe (LL) is the preferred graft choice. However, patient prognosis may still be poor even if graft volume (GV) selection criteria are met. Our aim was to evaluate the effects of right lobe (RL) donation when the LL graft selection criteria are met. Consecutive donors (n = 135) with preoperative LL graft volumetric GV/standard liver volume (SLV) of ≥35% and RL remnant of ≥35% were retrospectively studied. Patients were divided into 2 groups: LL graft and RL graft. Recipient's body surface area (BSA), Model for End-Stage Liver Disease (MELD) score, and the donor's age were higher in the RL group. The donor's BSA and preoperative volumetric GV/SLV of the LL graft were smaller in the RL group. The predicted score (calculated using data for graft size, donor age, MELD score, and the presence of portosystemic shunt, which correlated well with graft function and with 6-month graft survival) of the RL group, was significantly lower if the LL graft were used, but using the actual RL graft improved the score equal to that of the LL group. Six-month and 12-month graft survival rates did not differ between the 2 groups. In patients with a poor prognosis, a larger RL graft improved the predicted score and survival was equal to that of patients who received LL grafts. In conclusion, graft selection by GV, donor age, and recipient MELD score improves outcomes in LDLT. Liver Transplantation 22 914-922 2016 AASLD.
为确保活体肝移植(LDLT)中供体的安全,左叶和尾状叶(LL)是首选的移植肝选择。然而,即使满足了移植肝体积(GV)选择标准,患者的预后可能仍然较差。我们的目的是评估在满足LL移植选择标准时右叶(RL)供肝的影响。对连续135例术前LL移植肝体积GV/标准肝体积(SLV)≥35%且RL残余体积≥35%的供体进行回顾性研究。患者分为两组:LL移植组和RL移植组。RL组受者的体表面积(BSA)、终末期肝病模型(MELD)评分以及供体年龄更高。RL组供体的BSA和LL移植肝术前体积GV/SLV更小。如果使用LL移植肝,RL组的预测评分(使用移植肝大小、供体年龄、MELD评分和门体分流情况的数据计算,与移植肝功能和6个月移植肝存活率密切相关)显著更低,但使用实际的RL移植肝可使评分提高至与LL组相当。两组的6个月和12个月移植肝存活率无差异。在预后较差的患者中,更大的RL移植肝可提高预测评分,且存活率与接受LL移植肝的患者相当。总之,通过GV、供体年龄和受者MELD评分进行移植肝选择可改善LDLT的结局。《肝脏移植》22 914 - 922 2016美国肝病研究学会