没有同时进行切除术的成年活体捐赠者肝移植
Nobuhisa Akamatsu1, Kaito Fukuda1, Yujiro Nishioka1
1Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Hepatobiliary surgery and nutrition
|February 12, 2026
概括
活体供体肝移植 (LDLT) 可以在没有脊髓切除术的情况下取得成功. 植入物生存率不受植入物大小的显著影响,但老年捐赠者和脏-植入物不成比例增加了失败风险.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植手术 移植手术
- 外科手术的结果
背景情况:
- 在活体供体肝移植 (LDLT) 中,手术内输入调节的必要性,特别是同时进行切除术和分流绑定,以提高移植的存活率和预防小规模综合征 (SFSS),仍然是争论的主题.
- 这些在LDLT期间在一些中心使用的程序对门脉动力学产生相反的影响,使其整体益处不确定.
研究的目的:
- 评估移植体大小对成人LDLT受体结局的影响,这些LDLT没有同时进行脊髓切除术.
- 在这个患者队列中确定与移植存活相关的特定因素.
主要方法:
- 对234名没有同时进行脊髓切除术的成人LDLT接受者的回顾性分析.
- 使用移植与受体重量比率 (GRWR) 评估了移植尺寸,截止值为0.7%,定义了小型移植.
主要成果:
- 在小型移植 (GRWR <0.7%) 和非小型移植 (GRWR ≥0.7%) 组之间没有观察到1年,3年或5年的移植或患者存活率的显著差异.
- 移植失败的独立风险因素包括较老的捐赠者年龄 (>45岁) 和脏-移植尺寸不成比例 (<70%). 具有这两种因素的接受者表现出明显较差的移植存活率 (P<0.001).
- 移植后,接受者表现出血小板数量增加和移植体积增加,门静脉流量减少和分流/脏大小减少,无论移植体积如何.
结论:
- 成人LDLT可以成功地进行,而不需要例行同时进行脊髓切除术.
- 在脏-移植体大小显著不成比例的情况下,或在使用来自老捐赠者的移植物以减轻移植失败风险时,可以选择性考虑脏切除术.
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