Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Surgery, Kyushu University Beppu Hospital, Beppu, Japan.
Transplantation. 2024 Jul 1;108(7):1593-1604. doi: 10.1097/TP.0000000000004952. Epub 2024 Feb 27.
The consensus that portal venous pressure modulation, including splenectomy (Spx), prevents portal hypertension-related complications after living-donor liver transplantation (LDLT) has been established. However, little evidence about the risk factors for graft loss after simultaneous Spx during LDLT is available. This study aimed to identify the independent predictors of graft loss after simultaneous Spx during LDLT.
Data of 655 recipients who underwent LDLT between 1997 and 2021 were collected and separated into the simultaneous Spx group (n = 461) and no-Spx group (n = 194).
The simultaneous Spx group had significantly lower serum total bilirubin levels, drained ascites volumes, and prothrombin time-international normalized ratios on postoperative day 14 than the no-Spx group ( P < 0.001 for each). Incidences of small-for-size graft syndrome ( P < 0.001), acute cellular rejection ( P = 0.002), and sepsis ( P = 0.007) were significantly lower in the Spx group. Graft survival of the Spx group was significantly better than that of the no-Spx group ( P < 0.001; hazard ratio [HR], 1.788; 95% confidence interval, 1.214-2.431). A multivariate analysis revealed that 3 variables, platelet count ≤4.0 × 10 4 /mm 3 ( P = 0.029; HR, 2.873), donor age ≥60 y old ( P = 0.013; HR, 6.693), and portal venous pressure at closure ≥20 mm Hg ( P = 0.010; HR, 3.891), were independent predictors of graft loss within 6 mo after simultaneous Spx during LDLT.
Spx is a safe inflow modulation procedure with a positive impact on both postoperative complications and prognosis for most patients. However, patients with the 3 aforementioned independent factors could experience graft loss after LDLT.
人们已经达成共识，即门静脉压力调节（包括脾切除术[Spx]）可以预防活体供肝移植（LDLT）后与门静脉高压相关的并发症。然而，关于 LDLT 中同时进行 Spx 后移植物丢失的风险因素，目前几乎没有相关证据。本研究旨在确定 LDLT 中同时进行 Spx 后移植物丢失的独立预测因素。
收集了 1997 年至 2021 年期间接受 LDLT 的 655 例受者的数据，并将其分为同时进行 Spx 组（n=461）和未进行 Spx 组（n=194）。
术后第 14 天，同时进行 Spx 组的血清总胆红素水平、引流腹水体积和凝血酶原时间国际标准化比值均显著低于未进行 Spx 组（P<0.001）。同时进行 Spx 组的小肝综合征（P<0.001）、急性细胞排斥反应（P=0.002）和脓毒症（P=0.007）的发生率显著更低。Spx 组的移植物存活率显著优于未进行 Spx 组（P<0.001；风险比[HR]，1.788；95%置信区间，1.214-2.431）。多变量分析显示，3 个变量，血小板计数≤4.0×10 4 /mm 3（P=0.029；HR，2.873）、供者年龄≥60 岁（P=0.013；HR，6.693）和关闭时门静脉压力≥20 mm Hg（P=0.010；HR，3.891），是 LDLT 中同时进行 Spx 后 6 个月内移植物丢失的独立预测因素。
Spx 是一种安全的流入调节程序，对大多数患者的术后并发症和预后都有积极影响。然而，具有上述 3 个独立因素的患者在 LDLT 后可能会发生移植物丢失。
