Hepatopancreatobiliary Surgery and Liver Transplantation Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
Ann Surg. 2024 Nov 1;280(5):753-762. doi: 10.1097/SLA.0000000000006475. Epub 2024 Aug 7.
The Resection And Partial Liver Transplantation with Delayed total hepatectomy (RAPID) procedure involves left hepatectomy with orthotopic implantation of a left lobe and right portal vein ligation. This technique induces volumetric graft increase, allowing for a right completion hepatectomy within 15 days. Notably, there is a lack of data on the hemodynamics of small-for-size grafts exposed to portal overflow without triggering small-for-size syndrome.
A prospective single-center protocol included 8 living donors and 8 RAPID noncirrhotic recipients. Comprehensive clinical and biological data were collected, accompanied by intraoperative arterial and portal flow and pressure measurements. Early kinetic growth rate (eKGR%) and graft function were assessed using computed tomography and 99Tc-mebrofenin scintigraphy on postoperative days 7 and 14. Findings were compared with retrospective data from 13 left living donor liver transplantation (LDLT) recipients.
The median Graft-body weight ratio was 0.41% (interquartile range: 0.34-0.49), markedly lower than in LDLT. However, there was no significant difference in eKGR between RAPID and LDLT grafts. Sequential analysis revealed variable eKGR per day: 10.6% (7.8-13.2) in the first week and 7.6% (6-9.1) in the second week posttransplantation. Indexed portal flow (indexed portal vein flow) was significantly higher in RAPID compared with left LDLT ( P = 0.01). No hemodynamic parameters were found to correlate with regeneration speed. We modulated portal flow in 2 out of 8 cases.
This study presents the first report of hemodynamic and volumetric data for the RAPID technique. Despite initial graft volumes falling below conventional LDLT recommendations, the study highlights acceptable clinical outcomes.
切除和部分肝移植联合延迟全肝切除术（RAPID）手术包括左半肝切除术和原位植入左外叶，同时结扎右门静脉。该技术可使供肝体积增加，从而在 15 天内行右半肝完成肝切除术。值得注意的是，目前尚无关于门静脉分流无小肝综合征情况下，小体积肝移植的血流动力学数据。
前瞻性单中心方案纳入了 8 例活体供者和 8 例非肝硬化 RAPID 受者。收集了全面的临床和生物学数据，同时进行术中动脉和门静脉血流及压力测量。术后第 7 天和第 14 天，采用 CT 和 99Tc-美罗芬酸闪烁扫描评估早期动力学生长率（eKGR%）和移植物功能。结果与 13 例左半活体供肝移植（LDLT）受者的回顾性数据进行比较。
供肝与受者体重比的中位数为 0.41%（四分位距：0.34-0.49），明显低于 LDLT。但是，RAPID 和 LDLT 移植物的 eKGR 之间没有显著差异。连续分析显示每天的 eKGR 不同：术后第 1 周为 10.6%（7.8-13.2），第 2 周为 7.6%（6-9.1）。与左半 LDLT 相比，RAPID 的门静脉指数（门静脉指数）明显较高（P=0.01）。未发现血流动力学参数与再生速度相关。我们在 8 例中的 2 例中调节了门静脉血流。
本研究首次报道了 RAPID 技术的血流动力学和体积数据。尽管初始供肝体积低于传统 LDLT 的建议，但该研究显示出可接受的临床结果。
