The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, 600044, India.
The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India.
World J Surg. 2020 Jul;44(7):2385-2393. doi: 10.1007/s00268-020-05446-w.
Conventional wisdom dictates that a larger hepatectomy is more prone to complications. Consequently, with the donor safety as paramount, the transplant community has intuitively been proponents of left lobe donation in live donor liver transplantation (LDLT), thereby satisfying the tenet of double equipoise. More recently some data suggest that this may not always be the case, especially in established centres. Our aim was to compare right and left lobe donor outcomes in LDLT from a centre with cumulative experience.
Review of a prospectively collected database of right and left lobe liver donors operated between August 2009 and July 2017 was performed. Their preoperative demographics, operative and post-operative outcomes were compared.
Of 904 liver transplantations, 458 were right lobe donors [379 without middle hepatic vein (MHV), 79 with MHV] and 58 left lobe donors. There was a significant difference in GRWR and functional liver remnant between the right and left lobe donors (1.27 ± 0.45 vs. 1.03 ± 0.28 p = 0.004, and 63.2 ± 7.9 vs. 37.7 ± 16.3, respectively, p value). The end portal pressure (7 vs. 8 mmHg p = <0.001), peak bilirubin (1.6 ± 0.8 vs. 2.9 ± 1.5 p = <0.001) and day 5 bilirubin (0.8 ± 0.3 vs. 1.4 ± 0.9 p = <0.001) were significantly higher in right lobe donors. There was no difference in blood loss, duration of surgery or peak lactate between the groups. Complications (20.7% vs. 25.9% p = 0.48), including serious complications (Clavien-Dindo > III) (6.9% vs. 8.1% p = 0.95), duration of ICU and hospital stay, were comparable between the groups. Subgroup analysis between left lobe and right lobe with and without MHV donor was also comparable.
Though biochemical differences exist between the groups, no difference in outcomes was noted. Despite larger liver mass loss in right lobe donors, a strict protocol-based approach to donor selection leads to comparable outcomes between left lobe and right lobe donations.
传统观点认为，肝切除术的范围越大，发生并发症的风险就越高。因此，出于对供体安全的高度重视，肝移植界一直本能地支持活体肝移植（LDLT）中的左外叶捐献，从而满足双平衡的原则。最近，一些数据表明，在有经验的中心，情况可能并非总是如此。我们的目的是比较本中心累积经验的右叶和左叶供肝者的供肝者结局。
对 2009 年 8 月至 2017 年 7 月期间接受手术的右叶和左叶肝供者的前瞻性数据库进行了回顾性分析。比较了他们的术前人口统计学、手术和术后结果。
在 904 例肝移植中，458 例为右叶供者[379 例无中肝静脉（MHV），79 例有 MHV]，58 例为左叶供者。右叶和左叶供者的 GRWR 和功能性肝残留量有显著差异（分别为 1.27±0.45 和 1.03±0.28，p=0.004；63.2±7.9 和 37.7±16.3，p 值）。右叶供者的终末门静脉压（7 比 8mmHg，p<0.001）、峰值胆红素（1.6±0.8 比 2.9±1.5，p<0.001）和第 5 天胆红素（0.8±0.3 比 1.4±0.9，p<0.001）均显著升高。两组间的出血量、手术时间或峰值乳酸无差异。并发症（20.7%比 25.9%，p=0.48），包括严重并发症（Clavien-Dindo>III 级）（6.9%比 8.1%，p=0.95）、入住 ICU 和住院时间，两组间无差异。对有和无 MHV 供者的左叶和右叶亚组分析结果也相似。
尽管两组间存在生化差异，但在结果方面没有差异。尽管右叶供者的肝质量损失较大，但基于严格的方案选择供者，可导致左叶和右叶供肝的结局相当。
