Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Clin Transplant. 2021 Jun;35(6):e14299. doi: 10.1111/ctr.14299. Epub 2021 Apr 19.
The role of donor-recipient body size mismatch (DRSM) on outcomes after whole liver transplantation (LT) is not clearly defined. At our center, in presence of considerable DRSM, objective assessment of the donor liver by a radiology or intraoperative evaluation by procuring surgeon was incorporated. To evaluate the impact of DRSM on graft outcomes with this approach, adult deceased donor whole liver transplants between July 2001 and December 2017 at our center were studied. DRSM was considered when the donor-recipient body surface area (BSA) ratio (DR-BSAr) was either <0.69 or >1.25. There were 54 (3.2%) transplants with DR-BSAr <0.69 and 61 (3.6%) with DR-BSAr >1.25. One-year graft survival was 85% vs. 89% vs. 89%; (p = .64) for transplants with DR-BSArs of <0.69, 0.69-1.25, and >1.25, respectively. Early allograft dysfunction (EAD) (28% vs. 27% vs. 37%; p = .07), post-transplant coagulopathy, bilirubinemia, and renal function were also comparable. In conclusion, with the actual measurement of the donor liver and recipient abdominal cavity, significant DRSM did not have a negative impact on early and long-term outcomes. Routine measurement of donor liver size by radiology may be incorporated in liver allocation to improve utilization.
供体-受者体表面积比值（DR-BSAr）<0.69 或>1.25 时，认为存在供体-受者体型不匹配（DRSM）。本研究回顾性分析了 2001 年 7 月至 2017 年 12 月期间本中心行成人尸体供肝全肝移植患者的临床资料，旨在评估该方法中 DRSM 对移植物结局的影响。DRSM 存在时，通过影像学或供肝切取术外科医生的术中评估来客观评估供肝。研究对象中，DR-BSAr<0.69 的患者 54 例（3.2%），DR-BSAr>1.25 的患者 61 例（3.6%）。DR-BSAr<0.69、0.69-1.25 和>1.25 的患者 1 年移植物存活率分别为 85%、89%和 89%（p=0.64）。早期移植物功能障碍（EAD）（28%、27%和 37%；p=0.07）、移植后凝血功能障碍、胆红素血症和肾功能也相似。总之，通过实际测量供肝和受者的腹腔，明显的 DRSM 并未对早期和长期结局产生负面影响。可能需要通过影像学常规测量供肝大小，以改善供肝的利用。
