亲属活体右后叶供肝儿童肝移植一例

Living-related pediatric liver transplantation using the right posterior sector graft： a case report

目的探讨右后叶活体肝移植技术的供、受体评估条件及临床疗效。方法回顾分析1例亲属活体右后叶供肝儿童肝移植的临床资料及术后疗效。患儿为女性，8岁，体质量为28妇，诊断为胆汁淤积症合并肝硬化失代偿，拟行活体肝移植而收入院。患儿的标准肝体积（SLV）为727cm3，所需最小供肝体积为291cm3。供者为患儿母亲，38岁，体质量为53kg，术前三维影像分析软件预估的供者全肝体积为1071cm3，肝脏计算机断层扫描血管造影（CTA）图像显示供肝门静脉右后叶分支从门静脉主干独立发出（即为Ⅲ型门静脉），且肝动脉右后支在肝脏实质外分出。进一步的体积计算提示右后叶供肝体积为403cm3，占受者SLV的比例为55．4％。手术组于2015年1月为患儿实施了活体右后叶肝移植。结果供、受者术后均恢复顺利，受者使用他克莫司＋皮质激素预防排斥反应，并于术后22d出院，术后3个月行肝脏CTA检查显示移植肝情况良好，现已随访7个月。结论通过严格的供肝体积与解剖学筛选，活体右后叶供肝儿童肝移植可获得较好的临床疗效。

Objective To discuss the preoperative donor and recipient assessments and clinical outcomes of living donor liver transplantation （LDLT） using right posterior sector （RPS） grafts. Method We retrospectively analyzed the clinical data and postoperative outcomes of a pediatric patient who underwent living-related liver transplantation （LT） using the RPS graft. The patient was an 8- year-old girl weighing 28 kg. She was diagnosed with cholestasis disease and liver cirrhosis and was admitted to our department for LDLT. The standard liver volume （SLV） of this patient was 727 cm3 , and the minimum required graft volume for LDLT was 291 cm3. The donor was her mother, who was 38 years old and weighed 53 kg. Preoperative volumetric assessments showed that the donor＇s total liver volume was 1071 cm3. Computer tomography angiography （CTA） of the donor liver indicated that the RPS portal vein was branching off separately from the main portal vein （type III portal vein）, and the branching point of the RPS hepatic artery located outside the liver parenchyma. Further volumetric analysis showed that the volume of RPS graft was 403 cm3, accounting for 55.4% of recipients SLV. Then, LDLT using RPS graft was performed for this child in January 2015. Result The donor and the recipient both recovered smoothly. Initial immunosuppressive therapy consisted of a dual drug regimen of tacrolimus combined with methylprednisolone, and the recipient was discharged 22 days after LT. The CTA images 3 months after LT showed that the liver graft was working well. The patient has been followed up for more than 7 months. Conclusion Favorable outcomes after LDLT using RPS graft could be obtained in pediatric patients through strict volumetric and anatomical assessment of the donor liver.