Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China.
Transplantation. 2022 Dec 1;106(12):2370-2378. doi: 10.1097/TP.0000000000004213. Epub 2022 Jul 8.
Living donor liver transplantation (LDLT) is an established treatment for advanced liver disease. Whether right lobe (RL) or left lobe (LL) LDLT provides the best outcomes for donors and recipients remains contentious.
MedLine, Embase, PubMed, and Cochrane Central were searched to identify studies comparing RL- and LL-LDLT and reporting donor and/or recipient outcomes. Effect sizes were pooled using random-effect meta-analysis. Meta-regressions were used to explore heterogeneity.
Sixty-seven studies were included. RL donors were more likely to experience major complications (relative risk [RR] = 1.63; 95% confidence interval [CI] = 1.30-2.05; I2 = 19%) than LL donors; however, no difference was observed in the risk of any biliary complication (RR = 1.41; 95% CI = 0.91-2.20; I2 = 59%), bile leaks (RR = 1.56; 95% CI = 0.97-2.51; I2 = 52%), biliary strictures (RR = 0.99; 95% CI = 0.43-1.88; I2 = 27%), or postoperative death (RR = 0.51; 95% CI = 0.25-1.05; I2 = 0%). Among recipients, the incidence of major complications (RR = 0.85; 95% CI = 0.68-1.06; I2 = 21%), biliary complications (RR = 1.10; 95% CI = 0.91-1.33; I2 = 8%), and vascular complications (RR = 0.79; 95% CI = 0.44-1.43; I2 = 0%) was similar. Although the rate of small for size syndrome (RR = 0.47; 95% CI = 0.30-0.74; I2 = 0%) and postoperative deaths (RR = 0.62; 95% CI = 0.44-0.87; I2 = 0%) was lower among RL-LDLT recipients, no differences were observed in long-term graft (hazard ratio = 0.87; 95% CI = 0.55-1.38; I2 = 74%) and overall survival (hazard ratio = 0.86; 95% CI = 0.60-1.22; I2 = 44%).
LL donors experience fewer complications than RL donors, and LL-LDLT recipients had similar outcomes to RL-LDLT recipients. These findings suggest that LL-LDLT offers the best outcomes for living donors and similar outcomes for recipients when measures are taken to prevent small for size syndrome.
活体肝移植（LDLT）是治疗晚期肝病的一种成熟疗法。右半肝（RL）或左半肝（LL）LDLT 哪种方式对供体和受体的效果最佳，仍存在争议。
检索 MedLine、Embase、PubMed 和 Cochrane 中央数据库，以确定比较 RL 和 LL-LDLT 并报告供体和/或受体结局的研究。使用随机效应荟萃分析汇总效应量。使用荟萃回归探索异质性。
纳入 67 项研究。RL 供体发生主要并发症的风险高于 LL 供体（相对风险 [RR] = 1.63；95%置信区间 [CI] = 1.30-2.05；I2 = 19%）；然而，在任何胆道并发症（RR = 1.41；95% CI = 0.91-2.20；I2 = 59%）、胆漏（RR = 1.56；95% CI = 0.97-2.51；I2 = 52%）、胆道狭窄（RR = 0.99；95% CI = 0.43-1.88；I2 = 27%）或术后死亡（RR = 0.51；95% CI = 0.25-1.05；I2 = 0%）的风险方面，两组无差异。在受体中，主要并发症（RR = 0.85；95% CI = 0.68-1.06；I2 = 21%）、胆道并发症（RR = 1.10；95% CI = 0.91-1.33；I2 = 8%）和血管并发症（RR = 0.79；95% CI = 0.44-1.43；I2 = 0%）的发生率相似。虽然 RL-LDLT 受体的小肝综合征（RR = 0.47；95% CI = 0.30-0.74；I2 = 0%）和术后死亡（RR = 0.62；95% CI = 0.44-0.87；I2 = 0%）的发生率较低，但长期移植物（风险比 = 0.87；95% CI = 0.55-1.38；I2 = 74%）和总体生存率（风险比 = 0.86；95% CI = 0.60-1.22；I2 = 44%）无差异。
LL 供体比 RL 供体发生并发症少，LL-LDLT 受体与 RL-LDLT 受体的结局相似。这些发现表明，当采取措施预防小肝综合征时，LL-LDLT 为活体供体提供最佳效果，且对受体提供相似效果。
