Department of Hepatobiliary and Digestive Surgery, CHU Rennes, Pontchaillou Hospital, University of Rennes 1, Rennes, France.
Department of Medical Information and Medical Records, CHU Rennes, Pontchaillou Hospital, University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France.
Ann Transplant. 2022 Mar 8;27:e935892. doi: 10.12659/AOT.935892.
BACKGROUND Few series of cavoportal (CPA) or renoportal (RPA) anastomosis have been published and their survival rates have never been compared. The objective of this study was to evaluate perioperative and long-term outcomes of CPA and RPA in a nationwide multicentric series and to compare hemitranspositions (HT) to paired orthotopic liver transplantations (OLT). MATERIAL AND METHODS HT performed in France up to April 2019 were analyzed. Endpoints were the incidence of severe (Clavien-Dindo>IIIa) 90-day perioperative complications and long-term patient and graft survival. RESULTS Sixty-four HT (13 CPA, 51 RPA) were performed in 59 patients. The rates of perioperative CD>IIIa complications were 64% and 49% in patients with CPA and RPA, respectively (P=0.59), and the rates of portal thrombosis and ascites were 38.5% and 9.8% (p=0.023) and 53.8% and 21.6% (p=0.049) in patients with CPA and RPA, respectively. The patient and graft perioperative survival rates were 54.4% and 83.3% (HR=3.2; CI 95 [1.1-9.9]; p=0.039) and 54.4% and 77.1% (HR=2.2; CI 95 [0.77-6.4]; P=0.14) in the CPA and RPA groups, respectively. Five-year patient survival was 36.4% and 61.8% in the CPA and RPA groups, respectively (HR=2.5; CI95 [1-6.1]; P=0.039). Compared with OLT grafts, long-term HT graft survival rates were not different (HR=1.7; CI 95 [0.96-3.1]; P=0.066), while patient survival rates were lower in the HT group (HR=4.6; CI 95 [2-11]; P<0.001). CONCLUSIONS Compared to OLT, HT significantly reduces patient survival. Given the poor survival results of CPA, the indication deserves to be limited in the context of organ shortage and RPA should be preferred when HT is needed.
很少有关于腔静脉-门静脉（CPA）或肾静脉-门静脉（RPA）吻合术的系列报道，且其存活率从未被比较过。本研究的目的是在全国多中心系列研究中评估CPA 和 RPA 的围手术期和长期结果，并比较半转位（HT）和配对原位肝移植（OLT）。
分析了截至 2019 年 4 月在法国进行的 HT。终点为 90 天围手术期严重（Clavien-Dindo>IIIa）并发症的发生率以及患者和移植物的长期存活率。
在 59 名患者中进行了 64 例 HT（13 例 CPA，51 例 RPA）。CPA 和 RPA 患者的围手术期 CD>IIIa 并发症发生率分别为 64%和 49%（P=0.59），CPA 和 RPA 患者的门静脉血栓形成和腹水发生率分别为 38.5%和 9.8%（p=0.023）和 53.8%和 21.6%（p=0.049）。CPA 和 RPA 患者的围手术期患者和移植物存活率分别为 54.4%和 83.3%（HR=3.2；95%CI[1.1-9.9]；p=0.039）和 54.4%和 77.1%（HR=2.2；95%CI[0.77-6.4]；P=0.14）。CPA 和 RPA 组的 5 年患者存活率分别为 36.4%和 61.8%（HR=2.5；95%CI[1-6.1]；P=0.039）。与 OLT 移植物相比，长期 HT 移植物存活率无差异（HR=1.7；95%CI[0.96-3.1]；P=0.066），但 HT 组患者存活率较低（HR=4.6；95%CI[2-11]；P<0.001）。
与 OLT 相比，HT 显著降低了患者的存活率。鉴于 CPA 的存活率较差，在器官短缺的情况下，其适应证应受到限制，当需要 HT 时，应优先选择 RPA。
