Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Pediatr Surg Int. 2024 Aug 16;40(1):229. doi: 10.1007/s00383-024-05814-w.
BACKGROUND/PURPOSE: Living donor liver transplantation (LDLT) is vital for pediatric end-stage liver disease due to organ shortages. The graft-to-recipient weight ratio (GRWR) preoperatively measured predicts the outcomes of LDLT. We typically target between 0.8 and 3.0-4.0%, but the ideal GRWR remains controversial. We compared the outcomes of LDLT according to the GRWR to examine whether the criteria could be expanded while ensuring safety.
We retrospectively reviewed 99 patients who underwent LDLT in our department by dividing them into three groups according to their GRWR: Group S, with GRWR values lower than the normal range (GRWR < 0.8%); Group M, with GRWR values in the normal range (GRWR ≥ 0.8 to < 3.5%); and Group L, with GRWR values above the normal range (GRWR ≥ 3.5%).
In Groups S and L, 46.2 and 44.4% of patients underwent splenectomy and delayed abdominal wall closure, respectively. After these intraoperative adjustments, there were no significant differences between the groups in 5-year patient survival, 5-year graft survival, or the occurrence of post-transplantation thrombosis.
When the GRWR is beyond the normal threshold, the risk of complications associated with graft size might be reduced by adjustments to provide appropriate portal blood flow and by delayed abdominal wall closure.
背景/目的：由于器官短缺，活体供肝肝移植（LDLT）对于儿科终末期肝病至关重要。术前测量的移植物与受体重量比（GRWR）预测 LDLT 的结果。我们通常的目标是在 0.8 到 3.0-4.0%之间，但理想的 GRWR 仍存在争议。我们比较了根据 GRWR 进行 LDLT 的结果，以检查在确保安全的同时是否可以扩大标准。
我们通过将 99 名在我们科室接受 LDLT 的患者根据其 GRWR 分为三组进行回顾性研究：组 S，GRWR 值低于正常范围（GRWR<0.8%）；组 M，GRWR 值在正常范围内（GRWR≥0.8 至<3.5%）；和组 L，GRWR 值高于正常范围（GRWR≥3.5%）。
在组 S 和 L 中，分别有 46.2%和 44.4%的患者接受了脾切除术和延迟腹壁关闭术。在这些术中调整后，各组之间 5 年患者生存率、5 年移植物生存率或移植后血栓形成的发生率均无显著差异。
当 GRWR 超过正常阈值时，通过调整提供适当的门静脉血流和延迟腹壁关闭，可以降低与移植物大小相关的并发症风险。
