Ding Limin, Yu Xizhi, Zhang Rui, Qian Junjie, Zhang Wu, Wu Qinchuan, Zhou Lin, Yang Zhe, Zheng Shusen
Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
NHFPC Key Laboratory of Combined Multi-Organ Transplantation, Hangzhou 310003, China.
J Clin Med. 2023 May 31;12(11):3782. doi: 10.3390/jcm12113782.
The most effective treatment for end-stage liver diseases is liver transplantation, which is impeded by the shortage of donor livers. Split liver transplantation (SLT) is important for addressing the donor liver shortage. However, full-right full-left SLT for two adult recipients is globally rarely conducted. This study aimed to investigate the clinical outcomes of this technique.
We retrospectively analyzed the clinical data of 22 recipients who underwent full-right full-left SLT at Shulan (Hangzhou) Hospital between January, 2021 and September, 2022. The graft-to-recipient weight ratio (GRWR), cold ischemia time, operation time, length of the anhepatic phase, intraoperative blood loss, and red blood cell transfusion amount were all analyzed. The differences in liver function recovery after transplantation were compared between the left and right hemiliver groups. The postoperative complications and prognosis of the recipients were also analyzed.
The livers of 11 donors were transplanted into 22 adult recipients. The GRWR ranged from 1.16-1.65%, the cold ischemia time was 282.86 ± 134.87 min, the operation time was 371.32 ± 75.36 min, the anhepatic phase lasted 60.73 ± 19.00 min, the intraoperative blood loss was 759.09 ± 316.84 mL, and the red blood cell transfusion amount was 695.45 ± 393.67 mL. No significant difference in the levels of liver function markers, total bilirubin, aspartate aminotransferase, or alanine aminotransferase between left and right hemiliver groups at 1, 3, 5, 7, 14, and 28 d postoperatively was observed (both > 0.05). One recipient developed bile leakage 10 d after transplantation, which improved with endoscopic retrograde cholangiopancreatography-guided nasobiliary drainage and stent placement. Another developed portal vein thrombosis 12 d after transplantation and underwent portal vein thrombectomy and stenting to restore portal vein blood flow. A color Doppler ultrasound performed 2 d after transplantation revealed hepatic artery thrombosis in one patient, and thrombolytic therapy was administered to restore hepatic artery blood flow. The liver function of other patients recovered quickly after transplantation.
Full-right full-left SLT for two adult patients is an efficient way to increase the donor pool. It is safe and feasible with careful donor and recipient selection. Transplant hospitals with highly experienced surgeons in SLT are recommended to promote using full-right full-left SLT for two adult recipients.
终末期肝病最有效的治疗方法是肝移植，但供肝短缺阻碍了这一治疗方式。劈离式肝移植（SLT）对于解决供肝短缺问题具有重要意义。然而，为两名成年受者进行全右全左SLT在全球范围内很少开展。本研究旨在探讨该技术的临床疗效。
我们回顾性分析了2021年1月至2022年9月期间在树兰（杭州）医院接受全右全左SLT的22例受者的临床资料。分析了移植物与受者体重比（GRWR）、冷缺血时间、手术时间、无肝期时长、术中失血量及红细胞输注量。比较了左右半肝组移植后肝功能恢复的差异。还分析了受者的术后并发症及预后情况。
11例供者的肝脏被移植给22例成年受者。GRWR为1.16 - 1.65%，冷缺血时间为282.86±134.87分钟，手术时间为371.32±75.36分钟，无肝期持续60.73±19.00分钟，术中失血量为759.09±316.84毫升，红细胞输注量为695.45±393.67毫升。术后第1、3、5、7、14和28天，左右半肝组肝功能指标、总胆红素、天冬氨酸转氨酶或丙氨酸转氨酶水平均无显著差异（均>0.05）。1例受者在移植后10天发生胆漏，经内镜逆行胰胆管造影引导下鼻胆管引流及支架置入后好转。另1例在移植后12天发生门静脉血栓形成，接受门静脉血栓切除术及支架置入以恢复门静脉血流。1例患者在移植后2天经彩色多普勒超声检查发现肝动脉血栓形成，给予溶栓治疗以恢复肝动脉血流。其他患者移植后肝功能恢复迅速。
为两名成年患者进行全右全左SLT是增加供肝来源的有效方法。通过仔细选择供受者，该方法安全可行。建议具备经验丰富的SLT外科医生的移植医院推广为两名成年受者进行全右全左SLT。
