General Surgery Department, Faculty of Medicine, Cairo University, Egypt.
Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt.
Asian J Surg. 2021 Feb;44(2):452-458. doi: 10.1016/j.asjsur.2020.10.016. Epub 2020 Nov 12.
Recently, increasing evidence showed that small-for-size syndrome (SFSS) is a multifactorial disease which is precipitated by various perioperative factors other than graft size. We conducted the current work to evaluate perioperative effectors, which can increase the risk of SFSS following adult living-donor liver transplantation (LDLT).
This is a retrospective study on 110 adult cirrhotic cases (mean age of 48.4 ± 6.9 years old) who underwent adult LDLT. Most cases were males (89%). Cases were categorized into two groups based on the occurrence of SFSS. The groups were compared regarding preoperative (gender, age, comorbidities, baseline investigations), intraoperative (mean blood pressure and glucose; mean operation time; number of packed red cells, plasma, platelets, and cryoprecipitate units; time of cold and warm ischemia, and anhepatic phase; preclamping and post-reperfusion portal pressures), and postoperative factors (relevant investigations, hospital stay).
Postoperatively, 23 patients developed SFSS (20.9%). SFSS group had significantly lower preoperative graft recipient weight ratio (GRWR) (0.76 ± 0.1% versus 1.03 ± 0.15, respectively; p < 0.001), and elevated MELD scores (19 ± 2.1 versus 17.9 ± 4; p = 0.024). Preclamping and post-reperfusion portal pressures of ≥22.5 and 17.5 mmHg, exhibited a sensitivity of 95.7% and 91.3% and specificity of 87.4% and 88.9% respectively, for SFSS prediction.
SFSS risk is significantly linked to GRWR, MELD score, and intraoperative portal haemodynamics. Intraoperative portal haemodynamics exhibited good diagnostic accuracy for SFSS prediction and represented promising indicators for the prediction of SFSS.
越来越多的证据表明，小肝综合征（SFSS）是一种多因素疾病，除了移植物大小以外，还有各种围手术期因素会诱发 SFSS。我们进行了这项研究，旨在评估成人活体肝移植（LDLT）后可能增加 SFSS 风险的围手术期效应因子。
这是一项回顾性研究，共纳入 110 例肝硬化成人病例（平均年龄 48.4±6.9 岁），均接受了成人 LDLT。大多数病例为男性（89%）。根据 SFSS 的发生情况将病例分为两组。比较两组患者的术前（性别、年龄、合并症、基线检查）、术中（平均血压和血糖、平均手术时间、红细胞、血浆、血小板和冷沉淀单位数量、冷缺血和无肝期时间、预阻断和再灌注门静脉压）和术后因素（相关检查、住院时间）。
术后有 23 例患者发生 SFSS（20.9%）。SFSS 组术前的受体-供体体重比（GRWR）明显较低（分别为 0.76±0.1%和 1.03±0.15，p<0.001），MELD 评分较高（分别为 19±2.1 和 17.9±4，p=0.024）。预阻断和再灌注门静脉压≥22.5mmHg 和≥17.5mmHg 对 SFSS 的预测具有 95.7%和 91.3%的敏感性，87.4%和 88.9%的特异性。
SFSS 风险与 GRWR、MELD 评分和术中门静脉血流动力学密切相关。术中门静脉血流动力学对 SFSS 的预测具有较好的诊断准确性，是预测 SFSS 的有前途的指标。
