Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver& Biliary Sciences, Vasant Kunj-D2, New Delhi, 110070, India.
Department of Radiology, Institute of Liver & Biliary Sciences, New Delhi, India.
J Gastrointest Surg. 2021 Aug;25(8):1962-1972. doi: 10.1007/s11605-020-04776-3. Epub 2020 Aug 17.
MHV reconstruction is essential to avoid anterior sector congestion in adult live donor liver transplantation (LDLT) using a modified right lobe graft.
The objective of this study is to evaluate the graft and patient outcomes with single orifice outflow reconstruction technique (SORT) (RHV + neo-MHV combined reconstruction on IVC) vs. dual outflow reconstruction technique (DORT) (RHV and neo-MHV separately reconstructed on IVC) in a modified right lobe LDLT.
Prospectively collected data of consecutive patients undergoing LDLT from June 2011 to August 2018 were analyzed. The patients were divided into two groups: SORT (n = 207) and DORT (n = 108). The perioperative morbidity and mortality were compared between two groups.
The two groups were comparable in baseline preoperative characteristics. Intraoperatively, warm ischemia time (27 vs. 45 min, p < 0.001), anhepatic phase (132 vs. 159 min, p < 0.001), and operative time (680 vs. 840 min, p < 0.001) were significantly shorter in SORT group. SORT group also had significantly lower GRWR (0.92 vs. 1.06, p < 0.001) and higher portal flow (2.4 vs. 2.7 L/min, p = 0.02). Postoperatively, SORT group had lower peak AST (177 vs. 209 IU/L, p < 0.001), ALT (163 vs. 189 IU/L, p = 0.004), creatinine levels (0.98 vs. 1.10, p = 0.01), rate of severe sepsis (13.7% vs. 22.9%, p = 0.03), major morbidity (50.7% vs. 62.6%, p = 0.03), shorter ICU (9 vs. 14 days, p < 0.001), and hospital stay (21 vs. 26 days, p = 0.03). Overall survival rates were comparable.
A SORT leads to improved early graft function and perioperative morbidity in modified right lobe LDLT in spite of having lower GRWR and higher portal flow.
在使用改良右叶供肝进行成人活体肝移植（LDLT）时，为避免前区拥堵，需要进行 MHV 重建。
本研究旨在评估改良右叶 LDLT 中，单出口流出重建技术（SORT）（RHV+neo-MHV 在 IVC 上联合重建）与双出口流出重建技术（DORT）（RHV 和 neo-MHV 分别在 IVC 上重建）的移植物和患者预后。
对 2011 年 6 月至 2018 年 8 月连续接受 LDLT 的患者进行前瞻性数据收集，并进行分析。患者分为两组：SORT（n=207）和 DORT（n=108）。比较两组患者的围手术期发病率和死亡率。
两组患者的术前基线特征相当。术中，热缺血时间（27 分钟比 45 分钟，p<0.001）、无肝期（132 分钟比 159 分钟，p<0.001）和手术时间（680 分钟比 840 分钟，p<0.001）均显著缩短。SORT 组的 GRWR（0.92 比 1.06，p<0.001）更低，门静脉流量（2.4 升/分钟比 2.7 升/分钟，p=0.02）更高。术后，SORT 组的 AST（177 比 209 IU/L，p<0.001）、ALT（163 比 189 IU/L，p=0.004）、肌酐水平（0.98 比 1.10，p=0.01）、严重脓毒症发生率（13.7%比 22.9%，p=0.03）、主要并发症发生率（50.7%比 62.6%，p=0.03）、ICU 住院时间（9 天比 14 天，p<0.001）和总住院时间（21 天比 26 天，p=0.03）均较低。两组患者的总生存率相当。
尽管 SORT 组的 GRWR 较低，门静脉流量较高，但在改良右叶 LDLT 中，SORT 可改善移植物早期功能和围手术期并发症。
