The Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Clin Transplant. 2019 Jan;33(1):e13444. doi: 10.1111/ctr.13444. Epub 2018 Dec 5.
The aim of this study was to evaluate the effect of hepatic artery (HA) size mismatch anastomosis on outcomes after living-donor liver transplantation (LDLT).
After excluding 128 patients with the exclusion criteria among 233 LDLTs using the right lobe, 104 LDLT patients were divided into two groups: donor HA diameter that was greater than or equal to the recipient HA diameter (D ≥ R group; n = 79), and donor HA diameter that was smaller than the recipient HA diameter (D < R group; n = 25).
Hepatic artery-related complications occurred in only one patient (HA thrombosis; 1.0%) who was in the D < R group. The reconstructed HA flow in the D ≥ R group was significantly greater than that in the D < R group (P = 0.015). There was a higher incidence of anastomotic biliary stricture in the D < R group (32.0%) compared with the D ≥ R group (13.9%, P = 0.022) after LDLT. A multivariate analysis with Cox regression revealed that the HA anastomosis of the D < R group and hepaticojejunostomy were significant independent risk factors for postoperative anastomotic biliary stenosis.
Hepatic artery anastomosis with a donor HA diameter smaller than that of the recipient HA might be an independent risk factor for postoperative biliary stenosis after LDLT using the right lobe.
本研究旨在评估肝动脉（HA）大小不匹配吻合对活体肝移植（LDLT）后结局的影响。
在排除了 233 例右半肝 LDLT 中 128 例有排除标准的患者后，将 104 例 LDLT 患者分为两组：供肝 HA 直径大于或等于受体 HA 直径（D≥R 组；n=79）和供肝 HA 直径小于受体 HA 直径（D<R 组；n=25）。
只有一名（HA 血栓形成；1.0%）患者在 D<R 组发生与肝动脉相关的并发症。D≥R 组重建的 HA 流量明显大于 D<R 组（P=0.015）。与 D≥R 组（13.9%，P=0.022）相比，D<R 组在 LDLT 后吻合口胆管狭窄的发生率更高（32.0%）。Cox 回归多因素分析显示，D<R 组的 HA 吻合和胆肠吻合是术后吻合口胆管狭窄的独立危险因素。
与受体 HA 相比，供体 HA 直径较小的肝动脉吻合可能是右半肝 LDLT 后术后胆道狭窄的独立危险因素。
