Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Asian J Surg. 2019 Jan;42(1):172-179. doi: 10.1016/j.asjsur.2018.01.002. Epub 2018 Feb 14.
Morbidity rates after living donor hepatectomy vary greatly among centers. Donor morbidity in a tertiary center over the past two decades was revisited.
Clinical data and grading of complications were reviewed by a nontransplant surgeon based on Clavien 5 tier grading. Risk factors were analyzed.
In total, 473 consecutive living liver donors from 1997 to 2016 were included for analysis; 305 were right liver donors and 168 left liver donors, and the corresponding morbidity rates were 27.2% and 9.5%. The majority (81/99, 81.2%) of complications were grade I and II. Donors with morbidity compared with those without were significantly younger, nonoverweight body figure (BMI < 25), more as the right liver donors, and longer length of hospital stay. Right liver donation had significantly higher morbidity rates than did left liver donation in earlier periods (before 2011), but not thereafter. Multivariate modeling revealed that right lobe donation and overweight (BMI ≥ 25 kg/m) were significant factors associated with donor morbidity, with adjusted hazard ratios HR (95% confidence interval) of 3.401 (1.909-6.060) and 0.550 (0.304-0.996), respectively. Further, overweight was a paradoxical risk factor in right donor hepatectomy with HR 0.422 (0.209-0.851), but the effect was nonsignificant in left liver donors. Most complications in overweight donors were grade I and not specific to liver surgery.
The overall complication rate was 20.9%. Overweight might be protective against morbidity in right hepatectomy and warrants further deliberation.
活体供肝切除术后的发病率在各中心之间差异很大。本研究回顾了过去 20 年中一家三级中心的供体发病率。
由非移植外科医生根据 Clavien 5 级分级系统对临床数据和并发症分级进行回顾。分析了危险因素。
共纳入 1997 年至 2016 年连续 473 例活体肝供者进行分析；305 例为右半肝供者，168 例为左半肝供者，相应的发病率分别为 27.2%和 9.5%。大多数（81/99，81.2%）并发症为 I 级和 II 级。与无并发症的供者相比，有并发症的供者年龄更小，非超重体型（BMI<25），更多为右半肝供者，且住院时间更长。右半肝供肝在早期（2011 年前）的发病率明显高于左半肝供肝，但此后并非如此。多变量模型显示，右叶供肝和超重（BMI≥25kg/m2）是与供体发病率相关的显著因素，调整后的危险比 HR（95%置信区间）分别为 3.401（1.909-6.060）和 0.550（0.304-0.996）。此外，超重是右供体肝切除的一个矛盾的危险因素，HR 为 0.422（0.209-0.851），但在左半肝供者中无统计学意义。超重供者的大多数并发症为 I 级，与肝手术无关。
总体并发症发生率为 20.9%。超重可能对右半肝切除术的发病率有保护作用，值得进一步研究。
