劈离式肝移植治疗慢加急性肝功能衰竭9例

Acute-on-chronic liver failure treated by split liver transplantation:a single-center experience on9cases

目的:评估劈离式肝移植(split liver transplantation,SLT)应用于慢加急性肝功能衰竭(acute-on-chronic liver failure,ACLF)患者的短期疗效。方法:回顾性分析2021年3月至2022年5月本中心9例接受SLT的ACLF患者的术前术后资料,评估手术安全性及疗效。结果:9例ACLF患者术前亚太肝病研究学会慢加急性肝功能衰竭研究联盟(APASL ACLF Research consortium,AARC)评分8分1例,9分3例,10分3例,11分1例,12分1例,AARC-ACLF分级2级7例,3级2例。9例供体被成功劈离,其中经典式劈离4例,完全式劈离5例。9例ACLF患者中2例接受左半肝移植,3例接受右半肝移植,4例接受右三叶肝移植,经过SLT治疗后,9例均顺利出院,其中1例发生ClavienⅣa级并发症,2例发生ClavienⅢb级并发症,术后中位住院天数27 d,随访1年生存率100%,器官存活率88.9%。结论:对于ACLF患者,劈离式肝移植是一种安全可行的治疗方法。

Objective To evaluate the short-term efficacy of split liver transplantation(SLT)in patients with acute-on-chronic liver failure(ACLF).Methods The clinical data of 9 ACLF patients receiving SLT in our center from Mar 2021 to May 2022 were retrospectively analyzed to evaluate its safety and efficacy.Results The preoperative APASL ACLF Research consortium(AARC)score of the 9 ACLF patients was 8 points in 1 case,9 points in 3 cases,10 points in 3 cases,11 points in 1 case and 12 points in 1 case,7 cases were in AARC-ACLF grade 2,and 2 cases in grade 3.In-situ liver splitting was performed in 9 deceased donors,including 4 classical split cases,5 full size split cases.Among these 9 ACLF patients,2 received left half liver transplantation,3 received right half liver transplantation,and 4 received extended right lobe liver transplantation.After transplantation,all 9 recipients were discharged fully recovered,1 case developed Clavien grade IVa complication and 2 cases developed Clavien grade II b complication.After SLT treatment the median postoperative hospital stay was 27 days,the 1-year survival rate was 100%,and the organ survival rate was 88.9%.Conclusion Split liver transplantation is a safe and feasible treatment method for ACLFpatients.