Kim Jong Man, Chung Young Jae, Kim Sangjin, Rhu Jinsoo, Choi Gyu-Seong, Joh Jae-Won
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Oncol. 2021 Feb 24;10:609844. doi: 10.3389/fonc.2020.609844. eCollection 2020.
Inadequate liver volume and weight is a major source of morbidity and mortality after adult living donor liver transplantation (LDLT). The purpose of our study was to investigate HCC recurrence, graft failure, and patient survival according to change in right liver graft weight after histidine-tryptophan-ketoglutarate (HTK) solution perfusion in LDLT.
Two hundred twenty-eight patients underwent LDLT between 2013 and 2017. We calculated the change in graft weight by subtracting pre-perfusion graft weight from post-perfusion graft weight. Patients with increased graft weight were defined as the positive group, and patients with decreased graft weight were defined as the negative group.
After excluding patients who did not meet study criteria, 148 patients underwent right or extended right hepatectomy. The negative group included 89 patients (60.1%), and the positive group included 59 patients (39.9%). Median graft weight change was -28 g (range; -132-0 g) in the negative group and 21 g (range; 1-63 g) in the positive group (P<0.001). Median hospitalization time was longer for the positive group than the negative group (27 days vs. 23 days; P=0.048). There were no statistical differences in tumor characteristics, postoperative complications, early allograft dysfunction, or acute rejection between the two groups. Disease-free survival, death-censored graft survival, and patient survival were lower in the positive group than the negative group. Additionally, the positive group showed strong association with HCC recurrence, death-censored graft survival, and patient survival in multivariate analysis.
This study suggests that positive graft weight change during HTK solution perfusion indicates poor prognosis in LDLT.
肝脏体积和重量不足是成人活体肝移植（LDLT）后发病和死亡的主要原因。本研究的目的是根据组氨酸 - 色氨酸 - 酮戊二酸（HTK）溶液灌注后右肝移植重量的变化，探讨肝癌复发、移植物功能衰竭和患者生存率。
2013年至2017年间，228例患者接受了LDLT。我们通过灌注后移植物重量减去灌注前移植物重量来计算移植物重量的变化。移植物重量增加的患者定义为阳性组，移植物重量减少的患者定义为阴性组。
排除不符合研究标准的患者后，148例患者接受了右半肝或扩大右半肝切除术。阴性组包括89例患者（60.1%），阳性组包括59例患者（39.9%）。阴性组移植物重量变化中位数为 -28 g（范围：-132 - 0 g），阳性组为21 g（范围：1 - 63 g）（P<0.001）。阳性组的中位住院时间长于阴性组（27天对23天；P = 0.048）。两组在肿瘤特征、术后并发症、早期移植物功能障碍或急性排斥反应方面无统计学差异。阳性组的无病生存率、死亡截尾移植物生存率和患者生存率均低于阴性组。此外，在多变量分析中，阳性组与肝癌复发、死亡截尾移植物生存率和患者生存率密切相关。
本研究表明，HTK溶液灌注期间移植物重量变化为阳性表明LDLT预后不良。
