当受体肝动脉不可用时，肝移植中替代动脉吻合部位的比较。

Comparison of alternative arterial anastomosis site during liver transplantation when the recipient's hepatic artery is unusable.

作者信息

Beaurepaire Jean Marie, Orlando Francesco, Levi Sandri Giovanni Battista, Jezequel Caroline, Bardou-Jacquet Edouard, Camus Christophe, Lakehal Mohamed, Desfourneaux Veronique, Merdrignac Aude, Gaignard Elodie, Thobie Alexandre, Bergeat Damien, Meunier Bernard, Rayar Michel

机构信息

CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France.

Université Rennes 1, Faculté de Médecine, Rennes, France.

出版信息

Hepatobiliary Surg Nutr. 2022 Feb;11(1):1-12. doi: 10.21037/hbsn-20-10.

DOI:10.21037/hbsn-20-10

PMID:35284512

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8847870/

Abstract

BACKGROUND

Few studies have analyzed outcomes of liver transplantation (LT) when the recipient hepatic artery (HA) was not usable.

METHODS

We retrospectively evaluated the outcomes of LT performed using the different alternative sites to HA.

RESULTS

Between 2002 and 2017, 1,677 LT were performed in our institution among which 141 (8.4%) with unusable recipient HA were analyzed. Four groups were defined according to the site of anastomosis: the splenic artery (SA group, n=26), coeliac trunk (CT group, n=12), aorta using or not the donor's vessel (Ao group, n=91) and aorta using a vascular prosthesis (Ao-P group, n=12) as conduit. The median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups (5, 5, 8.5 and 16 for SA, CT, Ao and Ao-P group respectively, P=0.002), as well as fresh frozen plasma (4.5, 2.5, 10, 17 for the SA, CT, Ao and Ao-P groups respectively, P=0.001). Hospitalization duration was also significantly increased in the Ao and Ao-P groups (15, 16, 24, 26.5 days for the SA, CT, Ao and Ao-P groups respectively, P<0.001). The occurrence of early allograft dysfunction (EAD) (P=0.07) or arterial complications (P=0.26) was not statistically different. Level of factor V, INR, bilirubin and creatinine during the 7 postoperative days (POD) was significantly improved in the SA group. No difference was observed regarding graft (P=0.18) and patient (P=0.16) survival.

CONCLUSIONS

In case of unusable HA, intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta.

摘要

背景

很少有研究分析当受体肝动脉不可用时肝移植（LT）的结果。

方法

我们回顾性评估了使用不同肝动脉替代部位进行肝移植的结果。

结果

2002年至2017年期间，我们机构共进行了1677例肝移植，其中141例（8.4%）受体肝动脉不可用并纳入分析。根据吻合部位分为四组：脾动脉组（SA组，n = 26）、腹腔干组（CT组，n = 12）、使用或不使用供体血管的主动脉组（Ao组，n = 91）以及使用血管移植物作为管道的主动脉组（Ao - P组，n = 12）。术中红细胞输注中位数在Ao组和Ao - P组显著增加（SA组、CT组、Ao组和Ao - P组分别为5、5、8.5和16，P = 0.002），新鲜冰冻血浆输注量也是如此（SA组、CT组、Ao组和Ao - P组分别为4.5、2.5、10、17，P = 0.001）。Ao组和Ao - P组的住院时间也显著延长（SA组、CT组、Ao组和Ao - P组分别为15、16、24、26.5天，P < 0.001）。早期移植物功能障碍（EAD）（P = 0.07）或动脉并发症（P = 0.26）的发生率无统计学差异。术后7天（POD）内SA组的凝血因子V水平、国际标准化比值（INR）、胆红素和肌酐水平显著改善。在移植物存活（P = 0.18）和患者存活（P = 0.16）方面未观察到差异。