Navarro Jonathan Geograpo, Choi Gi Hong, Kim Myoung Soo, Jung Yoon Bin, Lee Jae Geun
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2019 May;98(19):e15212. doi: 10.1097/MD.0000000000015212.
In living-donor liver transplantation (LDLT), the right lobe graft is commonly utilized to prevent small-for-size syndrome, despite the considerable donor morbidity. Conversely, the feasibility of the left lobe graft and the right posterior section graft in smaller-sized recipients is now commonly employed with comparable outcomes to right lobe grafts. The efficacy of the right anterior section graft has rarely been reported.
A 56-year-old man, a heavy alcoholic beverage drinker for 20 years, presented in the emergency department with massive ascites and lethargy. He was previously admitted twice due to bleeding esophageal varices.
He was diagnosed with hepatic encephalopathy coma due to alcoholic liver cirrhosis. The Child-Turcotte-Pugh score was 11 (class C), and the Model for End-stage Liver Disease score was 21.62.
A LDTL was offered to the patient as the best treatment option available. The patient's 26-year-old son was found to be the only donor-compatible candidate for the LDTL.Preoperatively, the right lobe of the donor occupied 76.2% of the total liver volume exposing the donor to a small residual liver volume. The right posterior section and left lobe volumes were insufficient, providing a graft-to-recipient weight ratio of 0.42% and 0.38%, respectively. However, the right anterior section could fulfill an acceptable GRWR of 0.83%. Thus, a living donor right anterior sectionectomy was performed.
Clinical signs and symptoms and liver function improved following anterior section graft transplantation without complications.
The procurement of anterior section graft is technically feasible in selected patients, especially in high-volume liver centers.
在活体肝移植（LDLT）中，尽管供体并发症较多，但右叶移植物通常被用于预防小肝综合征。相反，左叶移植物和右后段移植物在较小体型受者中的可行性目前已普遍采用，其结果与右叶移植物相当。右前段移植物的疗效鲜有报道。
一名56岁男性，有20年重度酒精饮料饮用史，因大量腹水和嗜睡就诊于急诊科。他曾因食管静脉曲张破裂出血入院两次。
诊断为酒精性肝硬化所致肝性脑病昏迷。Child-Turcotte-Pugh评分为11分（C级），终末期肝病模型评分为21.62分。
为该患者提供了LDLT作为最佳治疗选择。发现患者26岁的儿子是唯一与LDLT供体匹配的候选人。术前，供体右叶占全肝体积的76.2%，使供体剩余肝体积较小。右后段和左叶体积不足，移植物与受者体重比分别为0.42%和0.38%。然而，右前段可实现可接受的移植物与受者体重比0.83%。因此，进行了活体供体右前段切除术。
前段移植物移植后临床症状和肝功能改善，无并发症。
在选定的患者中，尤其是在大容量肝脏中心，获取前段移植物在技术上是可行的。
