Matsudaira Shinichi, Ishizaki Yoichi, Yoshimoto Jiro, Fujiwara Noriko, Kawasaki Seiji
Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Transplant Direct. 2017 Feb 16;3(3):e138. doi: 10.1097/TXD.0000000000000652. eCollection 2017 Mar.
Intractable ascites is one of the causes of graft loss after adult-to-adult living donor liver transplantation (LDLT) using a small graft. Identification of factors associated with increasing posttransplant ascites has important implications for prevention and treatment.
All 59 consecutive adult patients who underwent left lobe LDLT without portal inflow modulation between October 2002 and February 2016 were prospectively enrolled. Factors associated with the average daily amount of ascites for 2 weeks after LDLT were assessed.
The median daily amount of ascites during the 2 weeks was 1052 mL (range, 52-3480 mL). Although 16 of the 59 patients developed intractable ascites, exceeding 1500 mL daily (massive ascites group), the remaining 43 patients produced less than 1500 mL of ascites daily (nonmassive ascites group). The presence of pretransplant ascites ( = 0.001), albumin ( = 0.011), albumin/globulin ratio ( = 0.026), cold ischemia time ( = 0.004), operation time ( = 0.022), and pretransplant portal vein pressure (PVP) ( = 0.047) differed significantly between the 2 groups. Neither posttransplant PVP nor portal vein flow differed between the 2 groups. The variables associated with intractable ascites that remained significant after logistic regression analysis were pretransplant PVP ( = 0.047) and cold ischemia time ( = 0.049). After appropriate fluid resuscitation for intractable ascites, 58 (98%) of the 59 recipients were discharged from hospital after removal of the indwelling drains.
It is important to shorten the scold ischemia time to reduce massive ascites after LDLT. Pretransplant portal hypertension is more closely associated with ascites production than posttransplant hemodynamic status.
顽固性腹水是成人对成人活体肝移植（LDLT）使用小体积移植物后移植物丢失的原因之一。识别与移植后腹水增加相关的因素对预防和治疗具有重要意义。
前瞻性纳入2002年10月至2016年2月期间连续接受左叶LDLT且未进行门静脉血流调节的59例成年患者。评估与LDLT后2周腹水日均量相关的因素。
2周内腹水的日均量中位数为1052 mL（范围52 - 3480 mL）。59例患者中有16例出现顽固性腹水，每日超过1500 mL（大量腹水组），其余43例患者每日产生的腹水少于1500 mL（非大量腹水组）。两组之间移植前腹水的存在情况（P = 0.001）、白蛋白（P = 0.011）、白蛋白/球蛋白比值（P = 0.026）、冷缺血时间（P = 0.004）、手术时间（P = 0.022）以及移植前门静脉压力（PVP）（P = 0.047）存在显著差异。两组之间移植后PVP和门静脉血流均无差异。经逻辑回归分析后，与顽固性腹水相关且仍具有显著意义的变量为移植前门静脉压力（P = 0.047）和冷缺血时间（P = 0.049）。对顽固性腹水进行适当的液体复苏后，59例受者中有58例（98%）在拔除留置引流管后出院。
缩短冷缺血时间对于减少LDLT后大量腹水很重要。移植前门静脉高压比移植后血流动力学状态与腹水产生的关系更密切。
