Sabra Tarek Abdelazeem, Okajima Hideaki, Yoshizawa Atsushi, Okamoto Tatsuya, Anazawa Takayuki, Ygi Shintaro, Hata Koichiro, Yasuchika Kentaro, Taura Kojiro, Hatano Etsuro, Kaido Toshimi, Uemoto Shinji
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of General Surgery, Graduate School of Medicine, Assiut University, Assiut, Egypt.
Pediatr Transplant. 2017 May;21(3). doi: 10.1111/petr.12888. Epub 2017 Jan 22.
PV reconstruction is an important aspect of LDLT, with post-transplant outcomes depending on PV reconstruction methods. However, it is unclear whether the preferential selection of these techniques is dependent on preoperative recipient characteristics. This retrospective study assessed whether preoperative recipient factors differed in pediatric patients who did and did not receive VGs for PV reconstruction. Of 113 pediatric patients who underwent LDLT from January 2010 to July 2015, 31 (27%) underwent PV reconstruction with VGs and the other 82 (73%) without VGs. The presence of collateral vessels (P<.0001) and ascites (P=.02); PV size (P<.001), thrombosis (P=.01) and the direction of flow (P=.01), Child-Pugh class A vs B/C liver function (P=.01), Alb concentration (P=.02), primary diagnosis: BA vs non-BA (P=.03), and previous abdominal surgery (P<.005) differed significantly in patients who did and did not receive VGs for PV reconstruction. PV complications, patient survival, and graft survival did not differ significantly in patients with and without VGs at 1-year follow-up. VGs should be harvested for recipients with pretransplant hypoplastic PV, intense collaterals, hepatofugal flow, poor liver status, or previous abdominal surgery.
门静脉重建是活体肝移植的一个重要方面，移植后的结果取决于门静脉重建方法。然而，这些技术的优先选择是否取决于术前受者特征尚不清楚。这项回顾性研究评估了接受和未接受静脉移植物进行门静脉重建的儿科患者术前受者因素是否存在差异。在2010年1月至2015年7月接受活体肝移植的113例儿科患者中，31例（27%）接受了静脉移植物门静脉重建，另外82例（73%）未接受静脉移植物门静脉重建。接受和未接受静脉移植物进行门静脉重建的患者在侧支血管的存在（P<0.0001）和腹水（P=0.02）；门静脉大小（P<0.001）、血栓形成（P=0.01）和血流方向（P=0.01）、Child-Pugh A级与B/C级肝功能（P=0.01）、白蛋白浓度（P=0.02）、主要诊断：胆管闭锁与非胆管闭锁（P=0.03）以及既往腹部手术（P<0.005）方面存在显著差异。在1年随访中，接受和未接受静脉移植物的患者门静脉并发症、患者生存率和移植物生存率无显著差异。对于术前门静脉发育不全、侧支丰富、肝外血流、肝功能差或既往有腹部手术史的受者，应采集静脉移植物。
