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理解肝移植后的局部血流动力学变化：不同的实体还是同一硬币的不同面？

Understanding Local Hemodynamic Changes After Liver Transplant: Different Entities or Simply Different Sides to the Same Coin?

作者信息

Calderon Novoa Francisco, Mattera Juan, de Santibañes Martín, Ardiles Victoria, Gadano Adrian, D'Agostino Daniel E, Fratantoni Eugenia, De Santibañes Eduardo, Pekolj Juan

机构信息

General Surgery Department Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Hepato-Pancreato-Biliary Surgery Section and Liver Transplant Unit, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

出版信息

Transplant Direct. 2022 Aug 18;8(9):e1369. doi: 10.1097/TXD.0000000000001369. eCollection 2022 Sep.

DOI:10.1097/TXD.0000000000001369
PMID:36313127
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9605796/
Abstract

Liver transplantation is an extremely complex procedure performed in an extremely complex patient. With a successful technique and acceptable long-term survival, a new challenge arose: overcoming donor shortage. Thus, living donor liver transplant and other techniques were developed. Aiming for donor safety, many liver transplant units attempted to push the viable limits in terms of size, retrieving smaller and smaller grafts for adult recipients. With these smaller grafts came numerous problems, concepts, and definitions. The spotlight is now aimed at the mirage of hemodynamic changes derived from the recipients prior alterations. This article focuses on the numerous hemodynamic syndromes, their definitions, causes, and management and interconnection with each other. The aim is to aid the physician in their recognition and treatment to improve liver transplantation success.

摘要

肝移植是在极其复杂的患者身上进行的极其复杂的手术。随着技术的成功以及可接受的长期生存率，出现了一个新的挑战：克服供体短缺。因此，活体供肝移植和其他技术得以发展。为了确保供体安全，许多肝移植单位试图在肝脏大小方面突破可行极限，为成年受者获取越来越小的移植物。这些较小的移植物带来了众多问题、概念和定义。现在，焦点集中在受者先前改变所引发的血流动力学变化的幻象上。本文重点关注众多血流动力学综合征、它们的定义、病因、管理以及相互之间的联系。目的是帮助医生进行识别和治疗，以提高肝移植的成功率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9531/9605796/55fc98f418d6/txd-8-e1369-g008.jpg
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本文引用的文献

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Impact of Pretransplantation CT on Liver Donation in Potential Deceased Organ Donors.移植前CT对潜在脑死亡器官捐献者肝脏捐献的影响
J Am Coll Surg. 2022 Feb 1;234(2):166-175. doi: 10.1097/XCS.0000000000000042.
2
Small-for-size syndrome in liver transplantation: Definition, pathophysiology and management.肝移植中的小肝综合征：定义、病理生理学和处理。
Hepatobiliary Pancreat Dis Int. 2020 Aug;19(4):334-341. doi: 10.1016/j.hbpd.2020.06.015. Epub 2020 Jun 30.
3
Complications after Liver Transplant Related to Preexisting Conditions: Diagnosis, Treatment, and Prevention.
与原有疾病相关的肝移植术后并发症：诊断、治疗和预防。
Radiographics. 2020 May-Jun;40(3):895-909. doi: 10.1148/rg.2019190120. Epub 2020 Apr 10.
4
Large-for-Size Orthotopic Liver Transplantation: a Systematic Review of Definitions, Outcomes, and Solutions.大体积供肝原位肝移植：定义、结果和解决方案的系统评价。
J Gastrointest Surg. 2020 May;24(5):1192-1200. doi: 10.1007/s11605-019-04505-5. Epub 2020 Jan 9.
5
Complications of liver transplant.肝移植的并发症。
Abdom Radiol (NY). 2021 Jan;46(1):43-67. doi: 10.1007/s00261-019-02340-5.
6
Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight Pediatric Recipients.低体重儿受体接受超小型供肝活体肝移植的近期和远期效果。
J Gastrointest Surg. 2019 Dec;23(12):2411-2420. doi: 10.1007/s11605-019-04188-y. Epub 2019 Mar 18.
7
Middle hepatic vein reconstruction in adult right lobe living donor liver transplantation improves recipient survival.成人右半肝活体肝移植中肝中静脉重建可改善受者生存。
Hepatobiliary Pancreat Dis Int. 2019 Apr;18(2):125-131. doi: 10.1016/j.hbpd.2019.01.006. Epub 2019 Jan 31.
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Primary Stent Placement for Hepatic Artery Stenosis After Liver Transplantation: Improving Primary Patency and Reintervention Rates.肝移植术后肝动脉狭窄的初次支架置入：提高原发性通畅率和再介入率。
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Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation.球囊扩张治疗小儿肝移植后肝静脉流出道梗阻。
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Extreme large-for-size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication.成人肝移植术后巨大肝体积综合征：预测潜在致命并发症的模型。
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