Cho JY, Suh KS, Kwon CH, Yi NJ, Lee HH, Park JW, Lee KW, Joh JW, Lee SK, Lee KU.
外科，首尔大学医学院，首尔，韩国。

为了跨越配型障碍，肝右叶移植被广泛的应用于活体肝移植（LDLT）中。我们评估了捐赠者的疗效，重点关注两个活体肝移植中心的捐赠者在肝右叶切除后的残肝体积（RLV），以此来指引捐赠者肝右叶切除术中安全的RLV。

在2002年1月至2003年12月期间，我们研究了连续146例进行肝右叶切除的捐赠者，并对其进行了至少12个月的随访。我们根据RLV将捐赠者分为两组：第一组捐赠者的RLV <35%（范围是26.9%--34.9%），共74人；第二组捐赠者的RLV≥35%（范围是35.0%--46.8%），共72人。研究过程中没有出现捐赠者死亡或威胁生命的并发症。第一组中术后平均血清天门冬氨酸转氨酶（AST）峰值和丙氨酸转氨酶（ALT）（IU/L）水平分别为219.5 +/- 79.9和231.5 +/- 83.3，第二组中则分别为210.3 +/- 81.6和225.8 +/- 93.0（P = 0.497和0.699）。第一组的平均血清总胆红素（TB）峰值水平要高于第二组，分别为3.4 +/- 1.6和2.8 +/- 1.4（P = 0.023）。根据Clavien系统得出，在总共23种主要并发症中，第一组出现了10种（13.5%），第二组出现了13种（18.1%）。

并发症包括出血（第一组3例，第二组6例；P=0.282）、肠梗阻（第一组3例，第二组1例；P=0.324）、胆漏（第一组4例，第二组4例；P=0.968）、肺炎（第一组无，第二组2例；P=0.149）。我们同时还比较了两组捐赠者出现的轻微并发症。总之，除了一过性肝内胆汁淤积之外，RLV<35%捐赠者的疗效与RLV≥35%捐赠者的疗效没有差别。因此，RLV<35%似乎并不是活体捐赠者进行肝右叶切除时的禁忌。

Outcome of donors with a remnant liver volume of less than 35% after right hepatectomy
Cho JY, Suh KS, Kwon CH, Yi NJ, Lee HH, Park JW, Lee KW, Joh JW, Lee SK, Lee KU.
Department of Surgery, Seoul National University College of Medicine, Chongno-gu, Seoul, Korea.

To overcome the barrier of size match, right lobe graft has been widely used in living donor liver transplantation (LDLT). We assessed donor outcome, with a focus on remnant liver volume (RLV) after right hepatectomy based on the experiences of 2 LDLT centers, as a means of guiding the establishment of safe RLV limits for donor right hepatectomy.

Between January 2002 and December 2003, a consecutive 146 liver donors who underwent right hepatectomy with at least 12 months of follow-up were enrolled in this study. Donors were grouped into 2 groups according to RLV: group 1 (n = 74), <35% (range, 26.9-34.9) and group 2 (n = 72), > or = 35% (35.0-46.8). No donors died or suffered a life-threatening complication. Mean peak serum postoperative aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (IU/L) levels were 219.5 +/- 79.9 and 231.5 +/- 83.3 in group 1 and 210.3 +/- 81.6 and 225.8 +/- 93.0 in group 2 (P = 0.497 and 0.699), respectively. Mean peak serum total bilirubin (TB) (mg/dL) level in group 1 (3.4 +/- 1.6) was higher than in group 2 (2.8 +/- 1.4; P = 0.023). Overall 23 (15.8%) major morbidities, 10 in group 1 (13.5%) and 13 in group 2 (18.1%), occurred according to Clavien's system (P = 0.939).

These included bleeding (n = 3 in group 1 and n = 6 in group 2; P = 0.282), ileus (n = 3 and 1; P = 0.324), biliary leakage (n = 4 and 4; P = 0.968), and pneumonia (n = 0 and 2; P = 0.149). Minor morbidities were also comparable in the 2 groups. In conclusion, the outcome of donors with an RLV of <35% was not different from that of donors with an RLV of > or = 35%, with the exception of transient cholestasis. Therefore, a remnant RLV of <35% does not appear to be a contraindication for right liver procurement in living donors.

Copyright 2006 AASLD. Liver Transpl. 2006 Feb;12(2):201-6.
PMID: 16447201 [PubMed - indexed for MEDLINE]

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