Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
Al Faisal University, Riyadh, Kingdom of Saudi Arabia.
Liver Transpl. 2018 Aug;24(8):1019-1030. doi: 10.1002/lt.25043.
Left lateral sectionectomy for donor hepatectomy is a well-established alternative to deceased donor pediatric liver transplantation. However, very little is available on the laparoscopic approach (laparoscopic left lateral sectionectomy [L-LLS]). With the aim to assess safety, reproducibility under proctorship, and outcomes following living donor liver transplantation in children, a comparative single-center series using propensity score matching (PSM) to evaluate open left lateral sectionectomy (O-LLS) versus L-LLS was carried out in a relatively short time period in a high-volume pediatric transplant center. A retrospective, observational, single-center, PSM study was conducted on 220 consecutive living donor hepatectomies from January 2011 to April 2017. The variables considered for PSM were as follows: year of operation, recipient age, indication for transplant, recipient weight, donor sex, donor age, and donor body mass index. After matching, 72 O-LLSs were fit to be compared with 72 L-LLSs. Operative time and warm ischemia time were significantly longer in L-LLSs, whereas blood loss and overall donor complication rates were significantly lower. Postoperative day 1 and 4 pain scores were significantly less in the L-LLS group (P = 0.015 and 0.003, respectively). The length of hospital stay was significantly shorter in L-LLS (4.6 versus 4.1 days; P = 0.014). Overall donor biliary complications were 9 (12.5%) and 1 (1.4%) for O-LLS and L-LLS (P = 0.022), respectively. Vascular complications occurred in 3 (4.2%) children without graft loss in the laparoscopic group. The 1-, 3-, and 5-year overall patient survival rates were 98.5%, 90.9%, and 90.9% in the O-LLS group and in the L-LLS group 94.3%, 92.7%, and 86.8% (P = 0.28). In conclusion, L-LLS for donor hepatectomy is a safe and reproducible technique yielding better donor perioperative outcomes with respect to the conventional approach with similar recipient outcomes.
左外叶切除术是一种成熟的供体肝切除术方法，可作为儿童尸体供肝肝移植的替代方法。然而，腹腔镜方法（腹腔镜左外叶切除术[L-LLS]）的相关信息却很少。为了评估安全性、在带教医生的指导下的可重复性以及儿童活体供肝移植后的结果，在一个高容量的儿科移植中心，在相对较短的时间内进行了一项使用倾向评分匹配（PSM）的单中心回顾性、观察性、PSM 研究，以评估开放左外叶切除术（O-LLS）与 L-LLS。该研究回顾性分析了 2011 年 1 月至 2017 年 4 月期间 220 例连续接受活体供肝切除术的患者，共纳入 72 例 O-LLS 和 72 例 L-LLS。进行 PSM 时考虑的变量如下：手术年份、受体年龄、移植适应证、受体体重、供体性别、供体年龄和供体体重指数。匹配后，72 例 O-LLS 与 72 例 L-LLS 相匹配。L-LLS 的手术时间和热缺血时间明显更长，而出血量和总供体并发症发生率明显更低。术后第 1 天和第 4 天的疼痛评分在 L-LLS 组明显较低（P=0.015 和 0.003）。L-LLS 的住院时间明显缩短（4.6 天与 4.1 天；P=0.014）。O-LLS 和 L-LLS 的总供体胆管并发症发生率分别为 9（12.5%）和 1（1.4%）（P=0.022）。腹腔镜组 3 例（4.2%）儿童发生血管并发症，无移植物丢失。O-LLS 组 1、3 和 5 年的总体患者生存率分别为 98.5%、90.9%和 90.9%，L-LLS 组分别为 94.3%、92.7%和 86.8%（P=0.28）。总之，L-LLS 用于供体肝切除术是一种安全且可重复的技术，与传统方法相比，可改善供体围手术期结局，并获得相似的受体结局。
