Fukazawa Kyota, Nishida Seigo
Division of Transplantation, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, Washington 98195, USA.
Division of Liver and Gastrointestinal Transplant, Department of Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida, USA.
J Hepatobiliary Pancreat Sci. 2016 Aug;23(8):457-66. doi: 10.1002/jhbp.371. Epub 2016 Jul 28.
Size mismatch is an unique and inevitable but critical issue in live donor liver transplantation. Unmatched metabolic demand of recipient as well as physiologic mismatch aggravates the damage to liver graft, inevitably leading to graft failure on recipient. Also, an excessive resection of liver graft for better recipient outcome in live donor liver transplant may jeopardize the healthy donor well-being and even put donor life in danger. There is a fine balance between resected graft volume required to meet the recipient's metabolic demand and residual graft volume required for donor safety. The obvious clinical necessity of finding that balance has prompted a clinical need and promoted the improvement of knowledge and development of management strategies for size-mismatched transplants. The development of the size-matching methodology has significantly improved graft outcome and recipient survival in live donor liver transplants. On the other hand, the effect of size mismatch in cadaveric transplants has never been observed as being so pronounced. The importance of matching of the donor recipient size has been unrecognized in cadaveric liver transplant. In this review, we attempt to summarize the current most updated knowledge on the subject, particularly addressing the definition and complications of size-mismatched cadaveric liver transplant, as well as management strategies.
大小不匹配是活体肝移植中一个独特、不可避免但至关重要的问题。受者代谢需求不匹配以及生理上的不匹配会加重对肝移植物的损害，不可避免地导致受者发生移植物功能衰竭。此外，在活体肝移植中，为了使受者获得更好的预后而过度切除肝移植物可能会危及供体的健康，甚至使供体生命处于危险之中。在满足受者代谢需求所需的切除移植物体积与供体安全所需的残余移植物体积之间存在着微妙的平衡。找到这种平衡的明显临床必要性引发了临床需求，并促进了对大小不匹配移植的认识提高和管理策略的发展。大小匹配方法的发展显著改善了活体肝移植的移植物预后和受者生存率。另一方面，尸体肝移植中大小不匹配的影响从未被观察到如此显著。尸体肝移植中供受者大小匹配的重要性一直未被认识到。在这篇综述中，我们试图总结关于这个主题的当前最新知识，特别讨论大小不匹配尸体肝移植的定义、并发症以及管理策略。
