Goldaracena Nicolas, Echeverri Juan, Selzner Markus
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
Clin Transplant. 2017 Feb;31(2). doi: 10.1111/ctr.12885. Epub 2017 Jan 11.
Due to the severe organ shortage and the increasing gap between the supply and demand for donor grafts, live donor liver transplantation (LDLT) has become an accepted and alternative technique for the expansion of the donor pool. However, donor safety and good recipient outcomes must be balanced regarding risk stratification and decision-making within this patient population. Small-for-size syndrome (SFSS) is one of the complications encountered after LDLT, thus increasing the burden of optimizing donor graft selection and effective treatments during its occurrence. A graft-to-recipient weight ratio (GRWR) <0.8 predisposes the graft to SFSS. However, other factors may induce this complication even without a graft-to-patient size mismatch. Several strategies to prevent this complication include portal vein flow and liver outflow modulation, as well as pharmacological treatment. Also, as an entity with a multifactorial etiology, outcomes vary between right-lobe, left-lobe, and posterior-lobe donation among series encountered in the literature. In this review, we analyze the pathophysiology and classification of this complication, the state-of-the-art on management of SFSS, and the outcomes regarding the best treatment strategy on this patient population.
由于严重的器官短缺以及供体移植物供需差距的不断扩大，活体供肝移植（LDLT）已成为扩大供体库的一种被认可的替代技术。然而，在该患者群体的风险分层和决策过程中，必须平衡供体安全和良好的受体结局。小体积肝综合征（SFSS）是LDLT术后遇到的并发症之一，因此增加了优化供体移植物选择以及在其发生期间进行有效治疗的负担。移植物与受体重量比（GRWR）<0.8会使移植物易患SFSS。然而，即使没有移植物与患者大小不匹配的情况，其他因素也可能诱发这种并发症。预防这种并发症的几种策略包括门静脉血流和肝流出道调节以及药物治疗。此外，作为一种具有多因素病因的实体，在文献中报道的系列病例中，右叶、左叶和后叶供肝的结局有所不同。在本综述中，我们分析了这种并发症的病理生理学和分类、SFSS的管理现状以及针对该患者群体最佳治疗策略的结局。
