完全劈离式肝移植术后肝再生影响因素研究

Influencing factors of liver regeneration after full-size split liver transplantation

目的研究影响完全劈离式肝移植(fSLT)术后肝再生的影响因素。方法收集2019年5月至2023年9月在宁波大学附属李惠利医院行劈离式肝移植手术的病例资料。测算受体术后(30±7)d移植物体积(GV)及初始移植物体积(IGV),计算术后肝再生率(LRR)。fSLT患者以LRR=30%分为高再生组与低再生组,比较两组供受体及围手术期资料差异。结果共纳入52例患者,fSLT低再生组16例,高再生组36例。fSLT低再生组供体年龄,供肝脂肪变情况,乙肝病毒相关性肝病患病率,术后病肝病理诊断恶性率,术中出血量、肝酶、移植物重量与受者体重比(GRWR)以及总胆红素水平(TBiL)均高于高再生组(P<0.05)。术后血小板计数水平均低于高再生组(P<0.05)。结论供体年龄、供肝脂肪变性、GRWR、乙肝病毒相关性肝病、受体原发病良恶性等可能是影响fSLT术后肝再生的重要因素,术后血小板及肝酶、胆红素水平是监测fSLT术后肝再生的重要指标。

Objective To investigate the factors influencing recipient liver regeneration after full-size split liver transplantation(fSLT).Methods The clinical data of patients undergoing split liver transplantation in the Affiliated Li Huili Hospital of Ningbo University from May 2019 to Sep 2023 were retrospectively collected.Graft volume(GV)and initial graft volume(IGV)at(30±7)days after operation were measured,and postoperative liver regeneration rate(LRR)was calculated.The patients undergoing fSLT were divided into high regeneration group and low regeneration group with LRR=30%as boundary.The differences of donor and recipient data and perioperative data between the two groups were compared.Results A total of 52 patients were included.The low fSLT regeneration group(16 cases)was compared with the high fSLT regeneration group(36 cases),and in high fSLT regeneration group donor age was lower,the donor liver steatosis was less,GRWR was lower,the incidence of hepatitis B virus-related liver disease was lower,the postoperative diagnosis of malignant liver disease was lower,the intraoperative blood loss was less,and the postoperative platelet count was higher.The levels of liver enzyme and total bilirubin(TBiL)were higher than those in high regeneration group(P<0.05).Conclusions Donor age,donor liver steatosis,GRWR,hepatitis B virus associated liver disease,and recipient pathogenesis are important factors affecting liver regeneration after fSLT.Postoperative platelet and liver enzyme levels are important indicators for monitoring liver regeneration after fSLT.