Department of Surgery, The University of Hong Kong, Hong Kong, China.
Department of Surgery, Queen Mary Hospital, Hong Kong, China.
Ann Surg. 2021 Dec 1;274(6):e1260-e1268. doi: 10.1097/SLA.0000000000003824.
The aim of this study was to determine the outcomes of living donor liver transplantation (LDLT) according to various graft-to-recipient weight ratio (GRWR).
The standard GRWR in LDLT is >0.8%. Our center accepted predicted GRWR ≥0.6% in selected patients.
Data from patients who underwent LDLT from 2001 to 2017 were included. Patients were stratified according to actual GRWR (Group 1:GRWR ≤0.6%; Group 2: 0.6%<GRWR≤ 0.8%; Group 3:GRWR >0.8%).
There were 545 LDLT (group 1 = 39; group 2 = 159; group 3 = 347) performed. Pretransplant predicted GRWR showed good correlation to actual GRWR (R2 = 0.834) and these figures differed within a ± 10%margin (P = 0.034) using an equivalence test. There were more left lobe grafts in group 1 (33.3%) than group 2 (10.7%) and 3 (2.9%). Median donor age was <35 years and steatosis >10% was rare.There was no difference in postoperative complication, vascular and biliary complication rate between groups. Over one-fifth (20.5%) of group 1 patients required portal flow modulation (PFM) and was higher than group 2 (3.1%) and group 3 (4%) (P = 0.001). Twenty-six patients developed small-for-size syndrome (SFSS): 5 of 39 (12.8%) in group 1 and 21 of 159 (13.2%) in group 2 and none in group 3 (P < 0.001). There were 2 hospital mortalities; otherwise, the remaining patients [24/26 (92.3%)] survive with a functional liver graft. The 5-year graft survival rates were 85.4% versus 87.8% versus 84.7% for group 1, 2, and 3, respectively (P = 0.718). GRWR did not predict worse survivals in multivariable analysis.
Graft size in LDLT can be lowered to 0.6% after careful recipient selection, with low incidence of SFSS and excellent outcomes. Accurate graft weight prediction, donor-recipient matching, meticulous surgical techniques, appropriate use of PFM, and vigilant perioperative care is important to the success of such approach.
本研究旨在根据不同的供肝与受者体重比（GRWR）来确定活体肝移植（LDLT）的结果。
LDLT 的标准 GRWR 为>0.8%。本中心在选定的患者中接受预测 GRWR≥0.6%。
纳入 2001 年至 2017 年期间接受 LDLT 的患者数据。根据实际 GRWR 将患者分为三组（组 1：GRWR≤0.6%；组 2：0.6%<GRWR≤0.8%；组 3：GRWR>0.8%）。
共进行了 545 例 LDLT（组 1=39；组 2=159；组 3=347）。移植前预测的 GRWR 与实际 GRWR 具有良好的相关性（R2=0.834），并且在使用等效性检验时，两者之间相差 10%以内（P=0.034）。组 1 中有更多的左外叶供肝（33.3%），而组 2 为 10.7%，组 3 为 2.9%。供者年龄中位数<35 岁，脂肪变性>10%的情况很少见。各组之间的术后并发症、血管和胆道并发症发生率无差异。组 1 中有超过五分之一（20.5%）的患者需要门静脉血流调节（PFM），明显高于组 2（3.1%）和组 3（4%）（P=0.001）。26 例发生小肝综合征（SFSS）：组 1 中有 5 例（12.8%），组 2 中有 21 例（13.2%），组 3 中无（P<0.001）。有 2 例院内死亡；否则，其余患者[26 例中的 24 例（92.3%）]均存活并具有功能正常的肝移植物。5 年的移植物存活率分别为组 1、组 2 和组 3 的 85.4%、87.8%和 84.7%（P=0.718）。多变量分析显示 GRWR 并未预测生存率下降。
在仔细选择受者后，LDLT 中的移植物大小可以降低至 0.6%，SFSS 的发生率较低，且结果良好。准确预测移植物重量、供者与受者匹配、精细的手术技术、适当使用 PFM 和密切的围手术期护理对于这种方法的成功至关重要。
