Department of Hepatopancreatobiliary and Liver Transplant Surgery, National Liver Institute, Menoufia University, Shebin El-koom, Egypt.
Department of Liver and Small Bowel Transplantation & HPB Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Pediatr Transplant. 2021 Sep;25(6):e14044. doi: 10.1111/petr.14044. Epub 2021 Jun 2.
There are still controversies in using the large left lateral segment in pediatrics LT, with the possibility of the problem of LFS grafts, and the use of monosegmental or reduced liver grafts in small infants. This study aimed to evaluate our experience with LFSG in pediatrics LT.
A cohort retrospective analysis was conducted including pediatric recipients who underwent LT between January 2011 and October 2019. We compared recipients with GRWR ≥ 4% (LFS) vs GRWR < 4% as an average for size grafts.
There were 331 pediatric LT, 74 patients with GRWR ≥ 4%, and 257 patients with GRWR < 4%. In the group of LFS grafts, temporary abdominal closure by silicon patch was done in 39 patients (52.7%), 2 patients (2.7%) had postoperative HAT, 3 patients (4.1%) early PVT, 1 patient (1.3%) bile leak, and 3 patients (4.1%) had wound infection, with no significant difference in these complications between the 2 groups. In patients with LFS- grafts, the 1-, 3-, 5-, and 7-year patients survival rates were 94.6%, 91.7%, 91.7%, and 91.7%, respectively, while the survival rates in patients of the other group were 96.1%, 92.6%, 91.9%, and 91.9%, respectively, with no significant difference (p = .85).
Using LFS graft by left lateral segment in pediatric LT with potential delayed abdominal closure is a safe and feasible option with good outcomes and unnecessary need for graft reduction if performed by an experienced multidisciplinary team.
在儿科左外叶段肝移植（LT）中使用大左外叶段仍然存在争议，可能存在左外侧叶供肝移植物功能不良的问题，以及在小婴儿中使用单节段或减小体积的肝移植物。本研究旨在评估我们在儿科 LT 中使用左外侧叶供肝移植物的经验。
进行了一项队列回顾性分析，纳入 2011 年 1 月至 2019 年 10 月期间接受 LT 的儿科受者。我们比较了 GRWR≥4%（大左外叶段）与 GRWR＜4%（平均大小供肝）的受者。
共有 331 例儿科 LT，74 例受者的 GRWR≥4%，257 例受者的 GRWR＜4%。在大左外叶段供肝组中，39 例（52.7%）患者行临时腹部闭合硅酮补丁，2 例（2.7%）患者术后发生肝动脉血栓形成（HAT），3 例（4.1%）患者早期发生门静脉血栓形成（PVT），1 例（1.3%）患者发生胆漏，3 例（4.1%）患者发生切口感染，两组间这些并发症无显著差异。大左外叶段供肝组患者的 1、3、5 和 7 年生存率分别为 94.6%、91.7%、91.7%和 91.7%，而另一组患者的生存率分别为 96.1%、92.6%、91.9%和 91.9%，两组间无显著差异（p=0.85）。
在儿科 LT 中使用左外叶段供肝移植物（如有必要可延迟关闭腹部）是一种安全可行的选择，如果由经验丰富的多学科团队进行操作，则无需进行供肝体积减小。
