Iwaki Kentaro, Yagi Shintaro, Morita Satoshi, Hamaguchi Yuhei, Masano Yuki, Yamamoto Gen, Ogawa Eri, Nagai Kazuyuki, Kamo Naoko, Hata Koichiro, Taura Kojiro, Okajima Hideaki, Kaido Toshimi, Uemoto Shinji
Department of Hepatobiliary, Pancreas and Transplant Surgery, Kyoto University, Kyoto, Japan.
Department of Hepatobiliary, Pancreas and Transplant Surgery, Kyoto University, Kyoto, Japan.
Transplant Proc. 2019 Jul-Aug;51(6):1779-1784. doi: 10.1016/j.transproceed.2019.03.038. Epub 2019 Jul 10.
After living donor liver transplantation, we encounter cases with massive ascites, which is difficult to manage. We analyzed the risk factors for massive ascites after living donor liver transplantation. The subjects were 100 adult recipients who underwent living donor liver transplantation at Kyoto University Hospital from 2013 to 2017. We retrospectively assessed patient, graft, operative factors, and percent fluid overload, which were defined as [(weight on the day - preoperative weight)/preoperative weight] × 100%. We defined the massive ascites group as having a14-day average ascites ≥ 2500 mL and the mild ascites group as having a 14-day average ascites < 2500 mL. Forty-seven patients were included in the massive group, and 53 patients were included in the mild group. There was no difference in short- and long-term survival. In multivariate analysis, the presence of preoperative ascites (P = .0008), 14-day average percent fluid overload ≥ 14.5% (P = .0095), graft-to-recipient weight ratio < 0.86 (P = .0253), and donors' age ≥ 47 years (P = .0466) were identified as independent risk factors for massive ascites after living donor liver transplantation. A liver graft with a small graft-to-recipient weight ratio or from an elderly donor, which may indicate poor graft quality, presence of preoperative ascites, and postoperative fluid overload were associated with massive ascites after living donor liver transplantation.
在活体肝移植后，我们遇到了大量腹水且难以处理的病例。我们分析了活体肝移植后出现大量腹水的危险因素。研究对象为2013年至2017年在京都大学医院接受活体肝移植的100名成年受者。我们回顾性评估了患者、移植物、手术因素以及液体超负荷百分比，液体超负荷百分比定义为[（术后当天体重 - 术前体重）/术前体重]×100%。我们将大量腹水组定义为14天平均腹水≥2500 mL，轻度腹水组定义为14天平均腹水<2500 mL。大量腹水组纳入47例患者，轻度腹水组纳入53例患者。短期和长期生存率无差异。多因素分析显示，术前腹水的存在（P = .0008）、14天平均液体超负荷百分比≥14.5%（P = .0095）、移植物与受者体重比<0.86（P = .0253）以及供者年龄≥47岁（P = .0466）被确定为活体肝移植后出现大量腹水的独立危险因素。移植物与受者体重比小或来自老年供者的肝移植物，可能提示移植物质量差、术前腹水的存在以及术后液体超负荷，这些与活体肝移植后出现大量腹水有关。
