Ikegami Toru, Kim Jong Man, Jung Dong-Hwan, Soejima Yuji, Kim Dong-Sik, Joh Jae-Won, Lee Sung-Gyu, Yoshizumi Tomoharu, Mori Masaki
Department of Surgery and Science, Kyushu University, Fukuoka, Japan.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Transplant. 2019 Dec 31;33(4):65-73. doi: 10.4285/jkstn.2019.33.4.65.
Early series in living donor liver transplantation (LDLT) in adults demonstrated a lower safe limit of graft volume standard liver volume ratio 25%-45%. A subsequent worldwide large LDLT series proposed a 0.8 graft recipient weight ratio (GRWR) to define small-for-size graft (SFSG) in adult LDLT. Thereafter, researchers identified innate and inevitable factors including changes in liver volume during imaging studies and graft shrinkage due to perfusion solution. Although the definition of small-for-size syndrome (SFSS) advocated in the 2000s was mainly based on prolonged cholestasis and ascites output, the term SFSS was inadequate to describe clinical manifestations possibly caused by multiple factors. Thus, the term "early allograft dysfunction (EAD)," characterized by total bilirubin >10 mg/dL or coagulopathy with international normalized ratio >1.6 on day 7, has become prevalent to describe graft dysfunction including SFSS after LDLT. Although various efforts have been made to overcome EAD in LDLT, graft selection to maintain an expected GRWR >0.8 and full venous drainage, as well as inflow modulation using splenic artery ligation, have become standard in recent LDLT.
成人活体肝移植（LDLT）早期的系列研究表明，移植肝体积与标准肝体积之比的安全下限较低，为25%-45%。随后一项全球范围的大型LDLT系列研究提出采用0.8的移植肝受体重量比（GRWR）来定义成人LDLT中的小体积移植肝（SFSG）。此后，研究人员确定了一些内在且不可避免的因素，包括影像学检查期间肝脏体积的变化以及灌注液导致的移植肝萎缩。尽管21世纪倡导的小体积综合征（SFSS）的定义主要基于胆汁淤积延长和腹水排出量，但“SFSS”这一术语不足以描述可能由多种因素引起的临床表现。因此，以术后第7天总胆红素>10mg/dL或国际标准化比值>1.6的凝血病为特征的“早期移植物功能障碍（EAD）”这一术语，已普遍用于描述LDLT术后包括SFSS在内的移植物功能障碍。尽管为克服LDLT中的EAD已做出了各种努力，但在最近的LDLT中，选择移植肝以维持预期的GRWR>0.8并实现充分的静脉引流，以及使用脾动脉结扎进行血流调节，已成为标准做法。
