Department of liver transplantation and HPB surgery, hopital Pitié-Salpêtrière, université Paris 6-Pierre-et-Marie-Curie, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Department of liver transplantation and HPB surgery, hôpital Beaujon, université Paris 7-Xavier-Bichat, Assistance publique-Hôpitaux de Paris, 92110 Clichy, France.
Clin Res Hepatol Gastroenterol. 2016 Nov;40(5):571-574. doi: 10.1016/j.clinre.2016.03.002. Epub 2016 May 4.
Living donor liver transplantation is limited by the donor's risk in case of right liver donation and by the risk of small-for-size syndrome on the recipient in case of left lobe transplantation. This study aimed at evaluating the feasibility and results of two-stage liver transplantation using auxiliary hyper small grafts harvested laparoscopically and discussing relevant technical insights and issues that still need to be overcome.
Retrospective analysis involving two patients operated at a tertiary referral center. The recipients underwent left lateral sectionectomy and then auxillary liver transplantation using laparoscopically harvested left lateral section. The native right liver was transiently left in place to sustain the initially small functional graft functional during its hypertrophy.
No donor experienced postoperative complication. After 7days, the hypertrophy rate was 112% (105-120). Doppler assessments during the first two postoperative weeks showed progressive portal vein inflow decrease in the right native livers and portal vein inflow increase in the grafts. Liver biopsies on postoperative day 7 showed no lesion of overperfusion. No recipient experienced liver failure or small-for-size syndrome. Second stage hepatectomy of the native liver was undertaken in one patient. In the other patient, biliary stenosis on postoperative day 30 precluded second stage hepatectomy. This patient required retransplantation after one year.
The current strategy increases donor safety and may allow increasing the pool of available grafts. Refinements in the management of the native right liver are however required to improve the feasibility rate of this strategy.
活体肝移植受到右肝供体捐献者风险的限制，以及左肝供体捐献时受体发生小肝综合征的风险的限制。本研究旨在评估使用腹腔镜采集的辅助超小移植物进行两阶段肝移植的可行性和结果，并讨论相关技术要点和仍需克服的问题。
回顾性分析了在一家三级转诊中心接受手术的 2 名患者。患者首先接受左外叶切除术，然后使用腹腔镜采集的左外叶进行辅助性肝移植。供体的右肝暂时保留原位，以维持最初较小的功能性移植物在其肥大期间的功能。
供体术后均无并发症。7 天后，移植物的增生率为 112%（105-120）。在术后前两周的多普勒评估中，显示右供体肝脏的门静脉流入逐渐减少，而移植物的门静脉流入增加。术后第 7 天的肝脏活检显示无灌注过度病变。无受体发生肝衰竭或小肝综合征。一名患者进行了第二期肝切除，另一名患者在术后第 30 天发生胆管狭窄，第二期肝切除无法进行。该患者在一年后需要再次接受肝移植。
目前的策略提高了供体的安全性，并可能增加可用移植物的数量。然而，需要改进对右供体肝脏的管理，以提高该策略的可行性。
