Addeo Pietro, De Mathelin Pierre, Paul Chloe, Bachellier Philippe
Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle Des Pathologies Digestives Et Hépatiques, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France 1, Avenue Moliere, 67098, Strasbourg, France.
Updates Surg. 2025 May 31. doi: 10.1007/s13304-025-02269-z.
Small body size has been associated with an increased hazard ratio for mortality and dropout on the liver transplantation (LT) waitlist especially in female candidates. These findings could be explained by differences in anthropometric between genders, mainly due to smaller right anteroposterior diameter (RAP) of the right abdominal cavity in female. Reduction of graft volume by partial hepatectomy namely ex situ right posterior liver sectionectomy (H6,7) has been recently described to reduce liver grafts in adults. At our center, 4 female recipients, median RAP of 14 cm underwent LT with liver undergoing H6,7 graft reduction. Upon reduction, the graft weight passed from a median of 1654 g (range, 1640-1800) to 1365 g (range, 1230-1450) while the ratio graft weight/RAP passed from 114 g/cm (mean 111, range 102-120) to 93.3 g/cm (mean 92, range 82-98.5). The median cold ischemia time was 411 min (range, 343-478 min) and at a median follow-up of 268 days, all patients were alive with no vascular nor biliary complications and no retransplantation. Ex situ right posterior liver sectionectomy (H6, 7) represents a valid technical option to overcome mismatch for small-body size adult during liver transplantation. The need for this procedure remains exceptional and limited to small-body size adult recipient in urgent need for LT (i.e., fulminant liver failure, impairment of general conditions, ACLF, cancers, etc.) in which split liver transplantation could not be realized and/or is not available.
体型较小与肝移植（LT）等待名单上死亡率和退出率的风险比增加有关，尤其是在女性候选者中。这些发现可以通过性别之间人体测量学的差异来解释，主要是因为女性右腹腔的右前后径（RAP）较小。最近有人描述通过部分肝切除术即异位右后肝段切除术（H6,7）来减少移植物体积，以减少成人肝移植中的肝脏移植物。在我们中心，4名女性受者，中位RAP为14 cm，接受了采用H6,7移植物缩小术的肝脏LT。缩小后，移植物重量从中位1654 g（范围1640 - 1800）降至1365 g（范围1230 - 1450），而移植物重量/RAP比值从114 g/cm（平均111，范围102 - 120）降至93.3 g/cm（平均92，范围82 - 98.5）。中位冷缺血时间为411分钟（范围343 - 478分钟），中位随访268天，所有患者均存活，无血管或胆道并发症，也未进行再次移植。异位右后肝段切除术（H6,7）是肝移植期间克服小体型成人不匹配问题的一种有效技术选择。这种手术的需求仍然很少，仅限于急需LT（即暴发性肝衰竭、一般状况受损、慢加急性肝衰竭、癌症等）的小体型成人受者，在这些情况下无法实现和/或无法获得劈离式肝移植。
