成人对成人活体肝移植：血流动力学评估、预后及受者选择

Adult-to-Adult Living Donor Liver Transplant: Hemodynamic Evaluation, Prognosis, and Recipient Selection.

作者信息

Nacif Lucas Souto, Zanini Leonardo Yuri, Waisberg Daniel Reis, Costa Dos Santos João Paulo, Pereira Juliana Marquezi, Pinheiro Rafael Soares, Rocha-Santos Vinicius, Martino Rodrigo Bronze, Arantes Rubens Macedo, Ducatti Liliana, Haddad Luciana, Galvão Flávio Henrique, Andraus Wellington, Carneiro-D'Albuquerque Luiz

机构信息

Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.

出版信息

Transplant Proc. 2020 Jun;52(5):1299-1302. doi: 10.1016/j.transproceed.2020.02.073. Epub 2020 Mar 25.

DOI:10.1016/j.transproceed.2020.02.073

PMID:32222385

Abstract

BACKGROUND

Living donor liver transplant (LDLT) is a well-established treatment for end-stage liver disease. A better recipient selection and hemodynamic evaluation may improve transplant outcomes. The aim of this study was to establish recipient parameters that could enhance the results of adult-to-adult LDLT.

METHODS

We performed a retrospective study of all adult-to-adult LDLTs from a single center between January 2006 and December 2018. Variables analyzed included demographic and clinical parameters, laboratory tests, performance of intraoperative temporary portocaval shunt (TPCS), graft weight/recipient weight ratio (GW/RW), preoperative portal vein thrombosis (PVT), previous major abdominal surgery, and patient survival. Patients were divided in 2 groups according to GW/RW (0.8% cutoff point).

RESULTS

A total of 92 adult-to-adult LDLTs were analyzed, encompassing 53 male patients (57.6%). Mean Model for End-Stage Liver Disease score was 13.97 (SD, 4.74), and 57 patients (61.95%) had Child-Pugh-Turcotte score B. Mean GW/RW was 1.1% (SD, 0.37%). Group 1 with GW/RW > 0.8% (n = 74) and group 2 with it ≤ 0.8% (n = 13) presented mean GW/RW of 1.14% (SD, 0.24%) and 0.69% (SD, 0.09%) and P < .01, respectively. Eighteen patients (19.56%) presented PVT, with a worse survival than those without PVT (P = .006). Sixteen patients (17.39%) with previous major abdominal or biliary operations also presented higher mortality (P = .341). Forty-six (50%) intraoperative TPCSs were performed with a better 1- and 3-year patient survival. Receiver operating characteristic curve analysis showed PVT area under the curve of 0.701 (95% CI, 0.526-0.876; P = .018), positive predictive value of 0.69, and negative predictive value of 0.62. Multivariate analysis showed important risk regarding PVT (odds ratio, 6.160; 95% CI, 1.566-24.223; P = .004) and retransplant (odds ratio, 4.452; 95% CI, 0.843-23.503; P = .06).

CONCLUSIONS

Better recipient selection without PVT or previous major abdominal surgery, an adequate GW/RW, and intraoperative TPCS with hemodynamic modulation significantly improve outcomes of adult-to-adult LDLT.

摘要

背景

活体供肝肝移植（LDLT）是治疗终末期肝病的一种成熟疗法。更好的受者选择和血流动力学评估可能会改善移植效果。本研究的目的是确定能够提高成人对成人LDLT效果的受者参数。

方法

我们对2006年1月至2018年12月期间来自单一中心的所有成人对成人LDLT进行了回顾性研究。分析的变量包括人口统计学和临床参数、实验室检查、术中临时门腔分流术（TPCS）的实施情况、移植物重量/受者体重比（GW/RW）、术前门静脉血栓形成（PVT）、既往腹部大手术史以及患者生存率。根据GW/RW（截断点为0.8%）将患者分为两组。

结果

共分析了92例成人对成人LDLT，其中男性患者53例（57.6%）。终末期肝病模型平均评分为13.97（标准差，4.74），57例患者（61.95%）的Child-Pugh-Turcotte评分为B级。平均GW/RW为1.1%（标准差，0.37%）。GW/RW>0.8%的第1组（n = 74）和GW/RW≤0.8%的第2组（n = 13）的平均GW/RW分别为1.14%（标准差，0.24%）和0.69%（标准差，0.09%），P<0.01。18例患者（19.56%）出现PVT，其生存率低于未出现PVT的患者（P = 0.006）。16例有既往腹部或胆道大手术史的患者（17.39%）的死亡率也较高（P = 0.341）。46例（50%）患者术中进行了TPCS，其1年和3年患者生存率更高。受试者工作特征曲线分析显示，PVT的曲线下面积为0.701（95%CI，0.526 - 0.876；P = 0.018），阳性预测值为0.69，阴性预测值为0.62。多因素分析显示，PVT（比值比，6.160；95%CI，1.566 - 24.223；P = 0.004）和再次移植（比值比，4.452；95%CI，0.843 - 23.503；P = 0.06）是重要风险因素。