Hsu H-W, Tsang L L, Ou H-Y, Huang T-L, Chen T-Y, Yu C-Y, Lim W-X, Tong Y-S, Chen C-L, Cheng Y-F
Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2018 Nov;50(9):2588-2592. doi: 10.1016/j.transproceed.2018.04.006. Epub 2018 Apr 11.
This study aims to investigate postdonation outcomes of adult living donor liver transplantation donors and remnant liver regeneration in different graft types.
A total of 236 adult living donor liver transplantation donors were classified into different groups: donors with <35% remnant liver volume (group A; n = 56) and donors with remnant liver volume ≥35% (group B, n = 180); left lobe grafts (LLG group; n = 98) including middle hepatic vein (MHV) and right lobe grafts (RLG group; n = 138) without MHV. The 98 LLG group donors were further classified into 2 subgroups based on hepatic venous drainage patterns: MHV-dominant (n = 20) and non-MHV-dominant (n = 78). The demographic data, postoperative laboratory data, complications, graft weight, remnant liver volume, remnant liver growth rate, and remnant liver regeneration rate (RLRR) after partial liver donation were analyzed.
The postoperative aspartate aminotransferase, alanine aminotransferase, total bilirubin, intensive care unit stays, and hospitalization stays were higher in A and RLG group donors. All the donor complications in our series were minor complications. The postoperative complication rate was higher in the A and RLG group, but failed to reach statistical significance. There was no significant difference in RLRR between the RLG/LLG and A/B groups. However, the MHV-dominant group had significantly lower RLRR than the non-MHV-dominant group (P < .05).
Small remnant liver volume donors (<35% remnant liver) have higher risks of developing postdonation minor complications. Left lobe liver donation in MHV-dominant donor candidates are a major concern.
本研究旨在调查成人活体肝移植供体的捐肝后结局以及不同移植物类型中残余肝的再生情况。
总共236例成人活体肝移植供体被分为不同组：残余肝体积<35%的供体（A组；n = 56）和残余肝体积≥35%的供体（B组，n = 180）；左叶移植物（LLG组；n = 98）包括肝中静脉（MHV）和无MHV的右叶移植物（RLG组；n = 138）。98例LLG组供体根据肝静脉引流模式进一步分为2个亚组：MHV主导型（n = 20）和非MHV主导型（n = 78）。分析部分肝捐献后的人口统计学数据、术后实验室数据、并发症、移植物重量、残余肝体积、残余肝生长率和残余肝再生率（RLRR）。
A组和RLG组供体术后的天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素、重症监护病房停留时间和住院时间均较高。本系列中所有供体并发症均为轻微并发症。A组和RLG组的术后并发症发生率较高，但未达到统计学意义。RLG/LLG组与A/B组之间的RLRR无显著差异。然而，MHV主导型组的RLRR显著低于非MHV主导型组（P <.05）。
残余肝体积小的供体（<35%残余肝）发生捐肝后轻微并发症的风险较高。对于MHV主导型供体候选者进行左叶肝捐献是一个主要问题。
