Fang Wen, Gotoh Kunihito, Kobayashi Shogo, Sasaki Kazuki, Iwagami Yoshifumi, Yamada Daisaku, Tomimaru Yoshito, Akita Hirofumi, Noda Takehiro, Takahashi Hidenori, Doki Yuichiro, Eguchi Hidetoshi, Umeshita Koji
Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Transplant Proc. 2022 Apr;54(3):690-695. doi: 10.1016/j.transproceed.2022.01.027. Epub 2022 Mar 10.
In recent years, the increasing number of obese individuals in Japan has made transplant teams sometimes forced to select candidates with a high body mass index (BMI) as marginal donors in living donor liver transplantation. However, data are lacking regarding the impact of a high BMI on the outcome for liver donors, particularly over the long term. Here, we aimed to clarify the impact of a high BMI on postoperative short- and long-term outcomes in liver donors.
We selected 80 cases that had complete 5-year data available from hepatectomies performed in 2005 to 2015 in our institute. We divided donors into overweight (BMI ≥ 25 kg/m, n = 16) and normal-weight (BMI < 25, n = 64) groups.
Preoperatively, the overweight group had significantly higher preoperative levels of serum alanine aminotransferase and γ-glutamyl transpeptidase and a larger liver volume than the normal-weight group. Although the overweight group had significantly greater intraoperative blood loss (660 ± 455 vs 312 ± 268 mL, P = .0018) and longer operation times (463 ± 88 vs 386 ± 79 min, P = .0013), the groups showed similar frequencies of postoperative complications. At 1 year post hepatectomy, liver regeneration and spleen enlargement ratios did not significantly differ between the 2 groups. Remarkably, the overweight group showed significantly higher serum γ-glutamyl transpeptidase levels over the long term.
Overweight status alone was not a risk factor for either short- or long-term postoperative outcomes after a donor hepatectomy. However, donors with elevated γ-glutamyl transpeptidase levels, which was frequent among overweight donors, may require special attention.
近年来，日本肥胖个体数量不断增加，这使得移植团队有时不得不选择体重指数（BMI）较高的候选人作为活体肝移植的边缘供体。然而，关于高BMI对肝脏供体结局的影响，尤其是长期影响的数据尚缺。在此，我们旨在阐明高BMI对肝脏供体术后短期和长期结局的影响。
我们选取了2005年至2015年在我院进行肝切除术且有完整5年数据的80例病例。我们将供体分为超重组（BMI≥25kg/m，n = 16）和正常体重组（BMI<25，n = 64）。
术前，超重组血清丙氨酸氨基转移酶和γ-谷氨酰转肽酶的术前水平显著高于正常体重组，且肝脏体积更大。虽然超重组术中失血量显著更多（660±455 vs 312±268mL，P = 0.0018），手术时间更长（463±88 vs 386±79分钟，P = 0.0013），但两组术后并发症的发生率相似。肝切除术后1年，两组的肝脏再生和脾脏肿大率无显著差异。值得注意的是，从长期来看，超重组血清γ-谷氨酰转肽酶水平显著更高。
单纯超重状态并非供体肝切除术后短期或长期结局的危险因素。然而，超重供体中常见的γ-谷氨酰转肽酶水平升高的供体可能需要特别关注。
