Jo Hye-Sung, Kim Dong-Sik, Gunasekaran Vasanthakumar, Krishnamurthy Jagadeesh, Toshima Takeo, Takahashi Ryugen, Kim Jae-Yoon, Krishnan Sathish Kumar, Okumura Shinya, Hara Takanobu, Shimata Keita, Haruki Koichiro, Minnee Robert C, Rammohan Ashwin, Gupta Subash, Yoshizumi Tomoharu, Ikegami Toru, Lee Kwang-Woong, Rela Mohamed
Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
The Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India.
Transplantation. 2025 Feb 1;109(2):e92-e100. doi: 10.1097/TP.0000000000005225. Epub 2024 Oct 8.
New diagnostic criteria have recently been established to classify small-for-size syndrome (SFSS) after living donor liver transplantation into 3 groups based on severity. This study aimed to evaluate the clinical impact of grade A SFSS and identify the mortality risk.
We collected data from 406 patients diagnosed with grade A SFSS after living donor liver transplantation. Grade A SFSS is characterized by total bilirubin >5 mg/dL on postoperative day (POD) 7 or total bilirubin >5 mg/dL or ascites >1 L/d on POD 14. After propensity score matching, 193 patients were categorized into the up-trend group, down-trend group, and ascites group, with 43 patients (22.3%) in the up-trend group (total bilirubin on POD 7 < POD 14), 107 patients (55.4%) in the down-trend group (total bilirubin on POD 7 > POD 14), and 43 patients (22.3%) in the ascites group (only satisfying ascites criteria).
There was no significant difference in survival between patients with grade A SFSS and those without SFSS ( P = 0.152). The up-trend group showed a higher 90-d mortality rate than the down-trend and ascites groups ( P = 0.025). The 1-y survival rate differed significantly between the groups (87.6%, 91.9%, and 97.7%, respectively; P = 0.044). The independent risk factors for survival were up-trend of total bilirubin, recipient age (65 y and older), model for end-stage liver disease score (≥30), and ABO incompatibility. Patients with ≥2 risk factors had worse survival rates than those with none and only 1 risk factor ( P < 0.001).
Although the survival rate was comparable between the grade A SFSS and non-SFSS cohorts, the up-trend group showed worse survival. Aggressive interventions should be considered for up-trend patients with risk factors.
最近已制定新的诊断标准，将活体肝移植术后小体积综合征（SFSS）根据严重程度分为3组。本研究旨在评估A级SFSS的临床影响并确定死亡风险。
我们收集了406例活体肝移植术后诊断为A级SFSS患者的数据。A级SFSS的特征为术后第7天总胆红素>5mg/dL或术后第14天总胆红素>5mg/dL或腹水>1L/d。经过倾向评分匹配后，193例患者被分为上升趋势组、下降趋势组和腹水组，上升趋势组43例（22.3%）（术后第7天总胆红素<术后第14天），下降趋势组107例（55.4%）（术后第7天总胆红素>术后第14天），腹水组43例（22.3%）（仅满足腹水标准）。
A级SFSS患者与无SFSS患者的生存率无显著差异（P = 0.152）。上升趋势组的90天死亡率高于下降趋势组和腹水组（P = 0.025）。各组1年生存率差异有统计学意义（分别为87.6%、91.9%和97.7%；P = 0.044）。生存的独立危险因素为总胆红素上升趋势、受者年龄（65岁及以上）、终末期肝病模型评分（≥30）和ABO血型不相容。有≥2个危险因素的患者生存率低于无危险因素和仅有1个危险因素的患者（P < 0.001）。
虽然A级SFSS队列与非SFSS队列的生存率相当，但上升趋势组的生存率较差。对于有危险因素的上升趋势患者应考虑积极干预。
