Digestive Surgery and Liver Transplantation, Hepatobiliary Center, Paul Brousse Hospital, Villejuif, France.
Université Paris-Sud, Orsay, France.
Liver Transpl. 2017 Oct;23(10):1294-1304. doi: 10.1002/lt.24835.
There is currently no tool available to predict extreme large-for-size (LFS) syndrome, a potentially disastrous complication after adult liver transplantation (LT). We aimed to identify the risk factors for extreme LFS and to build a simple predictive model. A cohort of consecutive patients who underwent LT with full grafts in a single institution was studied. The extreme LFS was defined by the impossibility to achieve direct fascial closure, even after delayed management, associated with early allograft dysfunction or nonfunction. Computed tomography scan-based measurements of the recipient were done at the lower extremity of the xiphoid. After 424 LTs for 394 patients, extreme LFS occurred in 10 (2.4%) cases. The 90-day mortality after extreme LFS was 40.0% versus 6.5% in other patients (P = 0.003). In the extreme LFS group, the male donor-female recipient combination was more often observed (80.0% versus 17.4%; P < 0.001). The graft weight (GW)/right anteroposterior (RAP) distance ratio was predictive of extreme LFS with the highest area under the curve (area under the curve, 0.95). The optimal cutoff was 100 (sensitivity, 100%; specificity, 88%). The other ratios based on height, weight, body mass index, body surface area, and standard liver volume exhibited lower predictive performance. The final multivariate model included the male donor-female recipient combination and the GW/RAP. When the GW to RAP ratio increases from 80, 100, to 120, the probability of extreme LFS was 2.6%, 9.6%, and 29.1% in the male donor-female recipient combination, and <1%, 1.2%, and 4.5% in other combinations. In conclusion, the GW/RAP ratio predicts extreme LFS and may be helpful to avoid futile refusal for morphological reasons or to anticipate situation at risk, especially in female recipients. Liver Transplantation 23 1294-1304 2017 AASLD.
目前尚无工具可预测超大肝（LFS）综合征，这是成人肝移植（LT）后一种潜在的灾难性并发症。我们旨在确定超大肝的危险因素并建立一个简单的预测模型。本研究纳入了在单家机构接受全肝移植的连续患者队列。通过 CT 扫描，在剑突的最下端测量受体的下肢。在 394 名患者的 424 例 LT 中，有 10 例（2.4%）发生了超大肝。与其他患者（90 天死亡率为 6.5%）相比，超大肝患者的 90 天死亡率为 40.0%（P = 0.003）。在超大肝组中，更常见的是男性供体-女性受体组合（80.0%对 17.4%；P<0.001）。肝移植重量（GW）/右前-后（RAP）距离比是预测超大肝的指标，曲线下面积最高（曲线下面积，0.95）。最佳截断值为 100（敏感性，100%；特异性，88%）。基于身高、体重、体重指数、体表面积和标准肝体积的其他比值显示出较低的预测性能。最终的多变量模型包括男性供体-女性受体组合和 GW/RAP。当 GW/RAP 比值从 80、100 增加到 120 时，在男性供体-女性受体组合中，超大肝的概率分别为 2.6%、9.6%和 29.1%，而在其他组合中，概率分别为<1%、1.2%和 4.5%。总之，GW/RAP 比值可预测超大肝，并有助于避免因形态原因而徒劳拒绝或预测高危情况，尤其是在女性受体中。肝移植 23 1294-1304 2017 AASLD。
