Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Clin Transplant. 2023 Sep;37(9):e15080. doi: 10.1111/ctr.15080. Epub 2023 Aug 2.
This meta-analysis aimed to investigate the acceptability of donor remnant liver volume (RLV) to total liver volume (TLV) ratio (RLV/TLV) being <30% as safe in living donor liver transplantations (LDLTs).
Online databases were searched from January 2000 to June 2022. Pooled odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects model.
One prospective and seven retrospective studies comprising 1935 patients (164 RLV/TLV <30% vs. 1771 RLV/TLV ≥30%) were included. Overall (OR = 1.82; 95% CI [1.24, 2.67]; p = .002) and minor (OR = 1.88; 95% CI [1.23, 2.88]; p = .004) morbidities were significantly lower in the RLV/TLV ≥30% group than in the RLV/TLV <30% group (OR = 1.82; 95% CI [1.24, 2.67]; p = .002). No significant differences were noted in the major morbidity, biliary complications, and hepatic dysfunction. Peak levels of bilirubin (SMD = .50; 95% CI [.07, .93]; p = .02) and international normalized ratio (SMD = .68; 95% CI [.04, 1.32]; p = .04) were significantly lower in the RLV/TLV ≥ 30% group than in the RLV/TLV <30% group. No significant differences were noted in the peak alanine transferase and aspartate transaminase levels and hospital stay.
Considering the safety of the donor as the top priority, the eligibility of a potential liver donor in LDLT whose RLV/TLV is expected to be <30% should not be accepted.
本荟萃分析旨在探讨活体肝移植（LDLT）中供肝残留肝体积（RLV）与总肝体积（TLV）的比值（RLV/TLV）<30%的可接受性是否安全。
从 2000 年 1 月至 2022 年 6 月，在线数据库进行检索。使用固定效应或随机效应模型计算汇总比值比（OR）和标准化均数差（SMD）及其 95%置信区间（CI）。
共纳入 1 项前瞻性研究和 7 项回顾性研究，共纳入 1935 例患者（164 例 RLV/TLV<30%与 1771 例 RLV/TLV≥30%）。总体（OR=1.82；95%CI[1.24,2.67]；p=0.002）和轻微（OR=1.88；95%CI[1.23,2.88]；p=0.004）并发症发生率在 RLV/TLV≥30%组显著低于 RLV/TLV<30%组（OR=1.82；95%CI[1.24,2.67]；p=0.002）。在主要并发症、胆漏和肝功能不全方面无显著差异。RLV/TLV≥30%组胆红素（SMD=0.50；95%CI[0.07,0.93]；p=0.02）和国际标准化比值（SMD=0.68；95%CI[0.04,1.32]；p=0.04）的峰值显著低于 RLV/TLV<30%组。RLV/TLV≥30%组的丙氨酸转氨酶和天冬氨酸转氨酶峰值水平和住院时间与 RLV/TLV<30%组无显著差异。
鉴于供者安全是重中之重，对于预计 RLV/TLV 小于 30%的潜在肝移植供者，不应接受其作为肝移植供者的资格。
