Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Hepatobiliary Pancreat Dis Int. 2019 Jun;18(3):206-213. doi: 10.1016/j.hbpd.2019.03.007. Epub 2019 Mar 29.
Small-for-size graft (SFSG) has emerged as one of the very contentions in adult-to-adult living donor liver transplantation (LDLT) as a certain graft size is related to recipients' prognosis. Graft-to-recipient weight ratio (GRWR) ≥0.8% was considered as a threshold to conduct LDLT. However, this also has been challenged over decades as a result of technique refinements. For a better understanding of SFSG in practice, we conducted this meta-analysis to compare the perioperative outcomes and long-term outcomes between patients adopting the grafts with a lower volume (GRWR < 0.8%, SFSG group) and sufficient volume (GRWR ≥ 0.8%, non-SFSG group) in adult-to-adult LDLT.
The studies comparing recipients adopting graft with a GRWR < 0.8% and ≥ 0.8% were searched by three authors independently in PubMed, Web of Science, Embase, the Cochrane Library, MEDLINE and Google Scholar databases until September 2018 and data were analyzed by RevMan 5.3.5.
Sixteen studies with a total of 3272 subjects were included in this meta-analysis. In terms of small-for-size syndrome (SFSS), no significant difference was found in subjects enrolled after year 2010 (before 2010, OR=3.00, 95% CI: 1.69-5.35, P = 0.0002; after 2010, OR=1.23, 95% CI: 0.79-1.90, P = 0.36; P for interaction: 0.02). There was no significant difference in operative duration, blood loss, cold ischemia time, biliary complications, acute rejection, postoperative bleeding, hospitalization time, perioperative mortality, and 1-, 3- and 5-year overall survival rates between two groups.
This meta-analysis suggested that adopting SFSG in adult LDLT has comparable outcomes to those with non-SFSG counterparts since 2010.
小体积供肝（SFSG）已成为成人活体肝移植（LDLT）中的一个非常有争议的问题，因为一定的供肝体积与受者的预后有关。肝移植与受体体重比（GRWR）≥0.8%被认为是进行 LDLT 的阈值。然而，由于技术的不断完善，这一标准在过去几十年中也受到了挑战。为了更好地理解实践中的 SFSG，我们进行了这项荟萃分析，比较了在成人 LDLT 中采用体积较小（GRWR<0.8%，SFSG 组）和体积足够（GRWR≥0.8%，非 SFSG 组）供肝的患者的围手术期结局和长期结局。
三位作者独立在 PubMed、Web of Science、Embase、Cochrane 图书馆、MEDLINE 和 Google Scholar 数据库中搜索比较接受 GRWR<0.8%和≥0.8%供肝的受者的研究，使用 RevMan 5.3.5 进行数据分析。
这项荟萃分析共纳入了 16 项研究，共计 3272 例患者。在小肝综合征（SFSS）方面，在 2010 年后入组的患者中，差异无统计学意义（2010 年前，OR=3.00，95%CI：1.69-5.35，P=0.0002；2010 年后，OR=1.23，95%CI：0.79-1.90，P=0.36；P 交互=0.02）。两组患者的手术时间、术中出血量、冷缺血时间、胆漏并发症、急性排斥反应、术后出血、住院时间、围手术期死亡率和 1、3、5 年总生存率差异均无统计学意义。
这项荟萃分析表明，自 2010 年以来，成人 LDLT 中采用 SFSG 的结果与非 SFSG 相似。
