Lipshutz GS, Patel S, Hiatt JR, Yersiz H, Farmer DG, McDiarmid SV, Ghobrial RM, Busuttil RW.
加州大学洛杉矶分校Dumont肝移植中心，外科，David Geffen医学院，洛杉矶，加利福尼亚 90095，美国

目前已经有几项关于患者在原位肝移植手术（OLT）时进行门腔静脉半转位术的研究。此外，该操作在儿童患者中的疗效尚缺乏系列报道。本研究分析了门腔静脉半转位术的经验，研究对象为在首次提出此操作程序的单一中心进行小儿肝移植的患者群。对于1997年1月1日至2004年12月31日期间在我机构进行小儿肝移植的所有患者，我们都进行了回顾性分析。研究期间，行OLT的320名小儿肝移植患者中，7名儿童接受了门腔静脉半转位术(2.2%)。5名儿童有胆道闭锁（BA）。4例为尸体全器官肝移植，其余4例为左外侧段原位尸体供者劈裂式肝移植（n = 3）或活体肝移植（n = 1）。一名患者接受的是尸体供者全器官移植，其后2/3段进行了再次移植；两次手术都用到了门腔静脉半转位术。平均热缺血时间为54 +/- 16分钟。3名患者出现了原发性移植物无功能；2名患者成功进行了再次移植，其余患者则在等待再次移植的过程中死亡。还有一名患者死于术后复发。有七分之四的患者长期存活，且在术后长达八年的时间内肝功能良好。总之，小儿原位肝移植中门腔静脉半转位术的患者有长期存活的可能性，但是与此同时，患者出现原发性移植物无功能的概率也会增加。选择合适的受体和捐赠类型对治疗效果至关重要。因此，作为建立门静脉流入的最后手段，应该慎用门腔静脉半转位术。Copyright 2006 AASLD
PMID: 16799947 [PubMed - indexed for MEDLINE]

Liver Transpl. 2006 Jul;12(7):1097-103.
Portocaval hemitransposition in pediatric liver transplant recipients: a single-center experience
Lipshutz GS, Patel S, Hiatt JR, Yersiz H, Farmer DG, McDiarmid SV, Ghobrial RM, Busuttil RW.
Dumont-UCLA Liver Transplant Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Few studies have reported a series of patients who have undergone portocaval hemitransposition at the time of orthotopic liver transplantation (OLT). Furthermore, no series report the outcome of pediatric patients who required the procedure. This work analyzes the experience with portocaval hemitransposition in the pediatric liver transplant population at a single center since the initial description of the procedure. We carried out a retrospective analysis of all pediatric liver transplants performed in our institution during the 8-year period from January 1, 1997, to December 31, 2004. Of 320 pediatric patients who received OLT during the study period, 7 underwent portocaval hemitransposition (2.2%). Five of the patients had biliary atresia. Four grafts were whole cadaveric livers, while the remaining 4 were left lateral segments from either in situ cadaveric split (n = 3) or living donation (n = 1). One patient received a whole cadaveric allograft and was retransplanted with a segment 2/3 graft; in both cases portocaval hemitransposition was utilized. Average warm ischemia time was 54 +/- 16 minutes. Three patients had primary nonfunction of the allograft; 2 were retransplanted with successful outcome, and the remaining patient died before retransplantation. Another patient died from recurrent disease. Four of 7 are long-term survivors and demonstrate good liver function as long as 8 years posttransplant. In conclusions, long-term survival is possible following OLT with portocaval hemitransposition in pediatric patients. However, rates of primary graft nonfunction can be high. Appropriate selection of recipient and type of donor graft are essential for good outcomes. Portocaval hemitransposition should be used cautiously and as a last resort to establish portovenous inflow. Copyright 2006 AASLD
PMID: 16799947 [PubMed - indexed for MEDLINE]

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