Shoreem Hany, Gad Emad Hamdy, Soliman Hosam, Hegazy Osama, Saleh Sherif, Zakaria Hazem, Ayoub Eslam, Kamel Yasmin, Abouelella Kalid, Ibrahim Tarek, Marawan Ibrahim
Hany Shoreem, Emad Hamdy Gad, Hosam Soliman, Osama Hegazy, Sherif Saleh, Hazem Zakaria, Eslam Ayoub, Kalid Abouelella, Tarek Ibrahim, Ibrahim Marawan, Hepatobiliary Surgery Department, National Liver Institute, Menoufiya University, Shibin El-Koum 32817, Egypt.
World J Hepatol. 2017 Jul 28;9(21):930-944. doi: 10.4254/wjh.v9.i21.930.
To analyze the incidence, risk factors, prevention, treatment and outcome of small for size syndrome (SFSS) after living donor liver transplantation (LDLT).
Through-out more than 10 years: During the period from April 2003 to the end of 2013, 174 adult-to-adults LDLT (A-ALDLT) had been performed at National Liver Institute, Menoufiya University, Shibin Elkoom, Egypt. We collected the data of those patients to do this cohort study that is a single-institution retrospective analysis of a prospectively collected database analyzing the incidence, risk factors, prevention, treatment and outcome of SFSS in a period started from the end of 2013 to the end of 2015. The median period of follow-up reached 40.50 m, range (0-144 m).
SFSS was diagnosed in 20 (11.5%) of our recipients. While extra-small graft [small for size graft (SFSG)], portal hypertension, steatosis and left lobe graft were significant predictors of SFSS in univariate analysis ( = 0.00, 0.04, 0.03, and 0.00 respectively); graft size was the only independent predictor of SFSS on multivariate analysis ( = 0.03). On the other hand, there was lower incidence of SFSS in patients with SFSG who underwent splenectomy [4/10 (40%) SFSS 3/7 (42.9%) no SFSS] but without statistical significance, However, there was none significant lower incidence of the syndrome in patients with right lobe (RL) graft when drainage of the right anterior and/or posterior liver sectors by middle hepatic vein, V5, V8, and/or right inferior vein was done [4/10 (28.6%) SFSS 52/152 (34.2%) no SFSS]. The 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients with SFSS were 30%, 30%, 25%, 25%, 25% and 25% respectively, while, the 6-mo, 1-, 3-, 5-, 7- and 10-year survival in patients without SFSS were 70.1%, 65.6%, 61.7%, 61%, 59.7%, and 59.7% respectively, with statistical significant difference ( = 0.00).
SFSG is the independent and main factor for occurrence of SFSS after A-ALDLT leading to poor outcome. However, the management of this catastrophe depends upon its prevention (., selecting graft with proper size, splenectomy to decrease portal venous inflow, and improving hepatic vein outflow by reconstructing large draining veins of the graft).
分析活体肝移植（LDLT）后小体积综合征（SFSS）的发生率、危险因素、预防、治疗及预后。
在10多年间：2003年4月至2013年底，埃及谢宾库姆市曼努菲亚大学国家肝脏研究所共进行了174例成人对成人的LDLT（A-ALDLT）。我们收集了这些患者的数据进行这项队列研究，这是一项对前瞻性收集的数据库进行的单机构回顾性分析，分析了2013年底至2015年底期间SFSS的发生率、危险因素、预防、治疗及预后。中位随访期达40.50个月，范围为（0 - 144个月）。
我们的受者中有20例（11.5%）被诊断为SFSS。在单因素分析中，超小移植物[小体积移植物（SFSG）]、门静脉高压、脂肪变性和左叶移植物是SFSS的显著预测因素（分别为P = 0.00、0.04、0.03和0.00）；在多因素分析中，移植物大小是SFSS的唯一独立预测因素（P = 0.03）。另一方面，接受脾切除术的SFSG患者中SFSS的发生率较低[4/10（40%）发生SFSS对3/7（42.9%）未发生SFSS]，但无统计学意义。然而，当通过肝中静脉、V5、V8和/或右下静脉对右前和/或右后肝段进行引流时，右叶（RL）移植物患者中该综合征的发生率无显著降低[发生SFSS的患者为4/10（28.6%）对未发生SFSS的患者为52/152（34.2%）]。发生SFSS的患者6个月、1年、3年、5年、7年和10年生存率分别为30%、...
SFSG是A-ALDLT后发生SFSS的独立且主要因素，导致预后不良。然而，应对这一严重情况取决于预防措施（如选择合适大小的移植物、脾切除术以减少门静脉血流以及通过重建移植物的大引流静脉改善肝静脉流出道）。 （注：原文中部分生存率数据未完整给出）
