活体肝移植小比重供肝受者并发症及生存率的分析

Feasibility of small size graft following living donor liver transplantation

目的分析成人间活体肝移植术移植物质量和受者体重比（GRWR）〈0．8％的供肝受者近期并发症及远期生存率。方法回顾性分析四川大学华西医院肝移植中心自2001年1月至2007年12月收治的92例资料齐全的活体肝移植患者的临床资料，其中男性85例，女性7例；年龄18～65岁，中位年龄42岁。除外双供肝3例，余89例患者中GRWR〈0．8％的患者15例，并根据供肝情况将受者分为小供肝组（n=15）和符合标准供肝组（n=74），比较两组患者的术后并发症发生率及生存率，同时分析影响小供肝受者生存率的可能因素。结果在GRWR〈0．8％的15例患者中，1例出现了典型的小肝综合征。两组在术后并发症发生率（χ^2=0．000，P=1．000）及生存率（χ^2=0．058，P=0．811）方面差异均无统计学意义，小供肝组流出道的重建情况与其生存率密切相关（χ^2=6．821，P=0．009）。结论GRWR〈0．8％并不是供肝选择的绝对禁忌指标，在保证移植肝流出道通畅的情况下，小供肝可以被考虑。

Objective To analyze the complication rate and survival rate of the patients whose graftrecipient weight ratio （GRWR） less than 0. 8% following living donor liver transplantation （LDLT） . Methods There were 92 consecutive LDLT patients from January 2001 to December 2007 in West China Hospital,Sichuan University. There were 85 males and 7 females aged from 18 to 65 years old （averged, 42 years old） and among which 89 patients were involved in the study. There were 15 patients whose GRWR less than 0. 8% （ group 1 ） ,while other 74 recipients were in group 2. Comparing the two groups＇ complication rates and survival rates and/~nding out the potential influencing factor of small-size-graft recipients＇ survival rate. Results The survival rates of group 1 and group 2 were 73.3% （11/15） and 71.6% （53/74）, respectively. The grade II-V complication rates of group 1 and group 2 were 46. 7% （7/15） and 48. 6% （36/74）, respectively. There were no difference in survival rates （ χ^2 = 0. 058, P = 0. 811 ） and complication rates （ χ^2 = 0. 000,P = 1. 000） between the two groups. Ascites volume of group 1 and group 2 were （ 1532 ± 322） ml and （ 1466 ± 110 ） ml, respectively （t = 0. 234, P = 0. 815 ）. The condition of the graft＇ s middle hepatic vein had significant influence on small-size-liver recipients＇ survival rates（χ^2=6. 821 ,P = 0. 009 ）. Conclusions GRWR 〈0. 8% is not the limitation of the living donor liver transplantation but the outflow tract of the graft must be unobstructed.