Wong Hoi She, Department of Surgery, the University of Hong Kong, Hong Kong, China.
World J Gastroenterol. 2017 Jun 21;23(23):4270-4277. doi: 10.3748/wjg.v23.i23.4270.
To analyze the outcomes of living-donor liver transplantation (LDLT) using left-lobe (LL) or right-lobe (RL) small-for-size (SFS) grafts.
Prospectively collected data of adult patients who underwent LDLT at our hospital in the period from January 2003 to December 2013 were reviewed. The patients were divided into the RL-LDLT group and the LL-LDLT group. The two groups were compared in terms of short- and long-term outcomes, including incidence of postoperative complication, graft function, graft survival, and patient survival. A SFS graft was defined as a graft with a ratio of graft weight (GW) to recipient standard liver volume (RSLV) (GW/RSLV) of < 50%. The Urata formula was used to estimate RSLV.
Totally 218 patients were included for analysis, with 199 patients in the RL-LDLT group and 19 patients in the LL-LDLT group. The two groups were similar in terms of age (median, 53 years in the RL-LDLT group and 52 years in the LL-LDLT group, = 0.997) but had significantly different ratios of men to women (165:34 in the RL-LDLT group and 8:11 in the LL-LDLT group, < 0.0001). The two groups were also significantly different in GW ( < 0.0001), GW/RSLV ( < 0.0001), and graft cold ischemic time ( = 0.007). When it comes to postoperative complication, the groups were comparable ( = 0.105). Five patients died in hospital, 4 (2%) in the RL-LDLT group and 1 (5.3%) in the LL-LDLT group ( = 0.918). There were 38 graft losses, 33 (16.6%) in the RL-LDLT group and 5 (26.3%) in the LL-LDLT group ( = 0.452). The 5-year graft survival rate was significantly better in the RL-LDLT group (95.2% 89.5%, = 0.049). The two groups had similar 5-year patient survival rates (RL-LDLT: 86.8%, LL-LDLT: 89.5%, = 0.476).
The use of SFS graft in LDLT requires careful tailor-made surgical planning and meticulous operation. LL-LDLT can be a good alternative to RL-LDLT with similar recipient outcomes but a lower donor risk. Further research into different patient conditions is needed in order to validate the use of LL graft.
分析使用左外叶（LL）或右外叶（RL）小体积供肝（SFS）进行活体肝移植（LDLT）的结果。
回顾性分析 2003 年 1 月至 2013 年 12 月期间在我院行 LDLT 的成年患者的前瞻性收集数据。患者分为 RL-LDLT 组和 LL-LDLT 组。比较两组患者的短期和长期结局，包括术后并发症发生率、移植物功能、移植物存活率和患者存活率。SFS 移植物定义为供体肝重（GW）与受体标准肝体积（RSLV）之比（GW/RSLV）＜50%的移植物。采用 Urata 公式估计 RSLV。
共纳入 218 例患者进行分析，其中 RL-LDLT 组 199 例，LL-LDLT 组 19 例。两组患者年龄（中位数，RL-LDLT 组 53 岁，LL-LDLT 组 52 岁， = 0.997）相似，但男女比例（RL-LDLT 组 165:34，LL-LDLT 组 8:11， ＜0.0001）有显著差异。两组 GW（ ＜0.0001）、GW/RSLV（ ＜0.0001）和移植物冷缺血时间（ = 0.007）也有显著差异。在术后并发症方面，两组无显著差异（ = 0.105）。5 例患者院内死亡，RL-LDLT 组 4 例（2%），LL-LDLT 组 1 例（5.3%）（ = 0.918）。38 例移植物失功，RL-LDLT 组 33 例（16.6%），LL-LDLT 组 5 例（26.3%）（ = 0.452）。RL-LDLT 组 5 年移植物存活率显著优于 RL-LDLT 组（95.2% 89.5%， = 0.049）。两组患者 5 年存活率相似（RL-LDLT：86.8%，LL-LDLT：89.5%， = 0.476）。
LDLT 中使用 SFS 移植物需要精心设计个体化手术方案和精细的手术操作。LL-LDLT 可以作为 RL-LDLT 的一种良好替代方法，具有相似的受体结局，但供体风险较低。需要进一步研究不同患者的情况，以验证 LL 移植物的使用。
