Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Clin Transplant. 2018 Jul;32(7):e13288. doi: 10.1111/ctr.13288. Epub 2018 Jun 19.
When a sufficiently high-quality liver is available, classic liver graft splitting is performed. In such cases, a small child receives the left-lateral split graft, with subsequent transplantation of the right-extended graft in an adult.
We analyzed 64 patients who received right-extended liver grafts from 2007 to 2015, and compared outcomes between cases of external vs in-house graft splitting.
We found excellent donor data and comparable recipient characteristics. Cold ischemic time was significantly longer for external (14 ± 2 hours; n = 38) vs internal (12 ± 2 hours; n = 26) liver graft splitting. Compared to the internal splitting group, the external liver graft splitting group showed significantly reduced 1- and 5-year patient survival (100% vs 84%; P = .035) and higher rates of biliary (24% vs 12%) and vascular (8% vs 0%) complications.
The outcomes following right-extended split LTX are disappointing given the excellent organ quality. External liver graft splitting was associated with worse outcome and surgical complication rates. This may be related to the prolonged cold ischemic time due to twofold transportation, as well as the ignorance of the splitting procedure details and related pitfalls.
当有足够高质量的肝脏可供使用时，会进行经典的肝脏移植分割。在这种情况下，一个小孩子会接受左外侧肝段移植，然后将右外侧延长肝段移植到成人身上。
我们分析了 2007 年至 2015 年期间接受右外侧肝段移植的 64 名患者，并比较了外部和内部肝段分割的结果。
我们发现供体数据良好，受体特征相似。外部（38 例）肝段分割的冷缺血时间明显长于内部（26 例）（14 ± 2 小时比 12 ± 2 小时）。与内部肝段分割组相比，外部肝段分割组的患者 1 年和 5 年生存率明显降低（100%比 84%；P =.035），胆道（24%比 12%）和血管（8%比 0%）并发症发生率更高。
考虑到器官质量良好，右外侧肝段移植的结果令人失望。外部肝段分割与较差的结果和手术并发症发生率相关。这可能与两倍的运输导致的冷缺血时间延长有关，以及对分割过程细节和相关陷阱的忽视有关。
