劈离式肝移植203例临床应用

Clinical application of split liver transplantation:a single center report of 203 cases

目的:探讨劈离式肝移植(SLT)临床应用的安全性与疗效。方法:本研究为回顾性病例系列研究。回顾性分析2014年7月至2023年7月中山大学附属第三医院肝脏外科暨肝移植中心连续完成的203例SLT、79例活体肝移植(LDLT)及1298例全肝移植(WLT)供者和受者的临床资料。203例SLT供者中,公民去世后捐献109名,离体劈离产生127个移植物,在体劈离产生76个移植物;成人受者90例,儿童受者113例。根据时间先后将SLT患者分为两组:SLT开展早期组40例(2014年7月至2017年12月),SLT技术成熟期组163例(2018年1月至2023年7月)。分析各组生存情况及影响SLT患者生存率的主要原因。生存分析采用Kaplan-Meier法和Log-rank检验。结果:SLT开展早期组受者术后1、3、5年累积生存率分别为74.58%、71.47%、71.47%,SLT技术成熟期组分别为88.03%、87.23%、87.23%,两组差异有统计学意义(χ^(2)=5.560,P=0.018)。LDLT组术后1、3、5年累积生存率分别为93.41%、93.41%、89.95%,WLT组分别为87.38%、81.98%、77.04%,SLT技术成熟期组、LDLT组和WLT组间差异无统计学意义(χ^(2)=4.016,P=0.134)。腹腔出血、感染、原发性移植肝无功能和门静脉血栓形成是SLT患者术后早期死亡主要原因。结论:在技术成熟的肝移植中心可实现与LDLT和WLT相当的疗效,但需要经过一定时间的学习曲线。

Objective To investigate the safety and therapeutic effect of split liver transplantation(SLT)in clinical application.Methods This is a retrospective case-series study.The clinical data of 203 consecutive SLT,79 living donor liver transplantation(LDLT)and 1298 whole liver transplantation(WLT)performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed.Two hundred and three SLT liver grafts were obtained from 109 donors.One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting.There were 90 adult recipients and 113 pediatric recipients.According to time,SLT patients were divided into two groups:the early SLT group(40 cases,from July 2014 to December 2017)and the mature SLT technology group(163 cases,from January 2018 to July 2023).The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed.The Kaplan-Meier method and Log-rank test were used for survival analysis.Results The cumulative survival rates at 1-,3-,and 5-year were 74.58%,71.47%,and 71.47%in the early SLT group,and 88.03%,87.23%,and 87.23%in the mature SLT group,respectively.Survival rates in the mature SLT group were significantly higher than those in the early SLT group(x?=5.560,P=0.018).The cumulative survival rates at 1-,3-and 5-year were 93.41%,93.41%,89.95%in the LDLT group and 87.38%,81.98%,77.04%in the WLT group,respectively.There was no significant difference among the mature SLT group,the LDLT group and the WLT group(x2=4.016,P=0.134).Abdominal hemorrhage,infection,primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death.Conclusion SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers,but it needs to go through a certain time learning curve.