成人右半肝活体肝移植中肝中静脉重建可改善受者生存。

Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival.

机构信息

Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.

出版信息

Hepatobiliary Pancreat Dis Int. 2019 Apr;18(2):125-131. doi: 10.1016/j.hbpd.2019.01.006. Epub 2019 Jan 31.

DOI:10.1016/j.hbpd.2019.01.006

PMID:30738719

Abstract

BACKGROUND

The efficacy and necessity of middle hepatic vein (MHV) reconstruction in adult-to-adult right lobe living donor liver transplantation (LDLT) remain controversial. The present study aimed to evaluate the survival beneficiary of MHV reconstructions in LDLT.

METHODS

We compared the clinical outcomes of liver recipients with MHV reconstruction (n = 101) and without MHV reconstruction (n = 43) who underwent LDLT using right lobe grafts at our institution from January 2006 to May 2017.

RESULTS

The overall survival (OS) rate of recipients with MHV reconstruction was significantly higher than that of those without MHV reconstruction in liver transplantation (P = 0.022; 5-yr OS: 76.2% vs 58.1%). The survival of two segments (segments 5 and 8) hepatic vein reconstruction was better than that of the only one segment (segment 5 or segment 8) hepatic vein reconstruction (P = 0.034; 5-yr OS: 83.6% vs 67.4%). The survival of using two straight vascular reconstructions was better than that using Y-shaped vascular reconstruction in liver transplantation with two segments hepatic vein reconstruction (P = 0.020; 5-yr OS: 100% vs 75.0%). The multivariate analysis demonstrated that MHV tributary reconstructions were an independent beneficiary prognostic factor for OS (hazard ratio=0.519, 95% CI: 0.282-0.954, P = 0.035). Biliary complications were significantly increased in recipients with MHV reconstruction (28.7% vs 11.6%, P = 0.027).

CONCLUSIONS

MHV reconstruction ensured excellent outflow drainage and favored recipient outcome. The MHV tributaries (segments 5 and 8) should be reconstructed as much as possible to enlarge the hepatic vein anastomosis and reduce congestion.

摘要

背景

在成人对成人右半肝活体肝移植（LDLT）中，中肝静脉（MHV）重建的疗效和必要性仍存在争议。本研究旨在评估 MHV 重建在 LDLT 中的生存获益。

方法

我们比较了 2006 年 1 月至 2017 年 5 月在我院行右半肝供肝 LDLT 的 101 例接受 MHV 重建和 43 例未接受 MHV 重建的肝受体的临床结局。

结果

接受 MHV 重建的肝受体的总体生存率（OS）明显高于未接受 MHV 重建的肝受体（P=0.022；5 年 OS：76.2% vs 58.1%）。两段（5 段和 8 段）肝静脉重建的生存情况好于一段（5 段或 8 段）肝静脉重建（P=0.034；5 年 OS：83.6% vs 67.4%）。两段肝静脉重建中，使用两段直血管重建的生存情况好于使用 Y 型血管重建（P=0.020；5 年 OS：100% vs 75.0%）。多因素分析表明，MHV 属支重建是 OS 的独立受益预后因素（危险比=0.519，95%可信区间：0.282-0.954，P=0.035）。接受 MHV 重建的肝受体的胆漏并发症明显增加（28.7% vs 11.6%，P=0.027）。