Impact of the ratio of graft kidney volume to recipient body surface area on graft function after live donor kidney transplantation

Functioning nephron mass is a determinant of the graft function of kidney transplant recipients. The graft kidney volume and its weight have been reported to be surrogates of the nephron mass. To investigate the impact of the ratios of the surrogates to recipient body surface area (BSA) and body weight on the graft function within six months post-transplantation, we measured the graft kidney volume, using computed tomography with 3-dimensional reconstruction before transplantation, and measured the graft kidney weight during surgery. Ninety-four cases of live donor kidney transplants were included in this study. The graft kidney volume/recipient BSA ratio was correlated with the glomerular filtration rate (GFR) of recipients at one and six months post-transplantation (r = 0.416, p < 0.001 and r = 0.381, p < 0.001, respectively). We found a difference in the graft function between recipients with a graft kidney volume/recipient BSA ratio of ≥90.9 mL/m(2) and those with a ratio of <90.9 mL/m(2) (p < 0.001). Multivariate analysis demonstrated that the graft kidney volume/recipient BSA ratio and donor age are independent predictors of recipient GFR at one and six months post-transplantation (p < 0.05). During living donor and recipient matching, both the potential volume of the donated kidney and the body size of recipient should be considered.     

双肝移植后移植物萎缩的动物实验探究

目的通过动物实验验证临床双肝移植后移植物萎缩的现象。 方法清洁级雄性SD大鼠18只,8～10周龄,体质量230～250 g,术前禁食12 h。12只SD大鼠作为供体,6只作为受体。建立大鼠双肝移植模型,通过磁共振检查观测受体大鼠术后移植物体积变化。采用成组t检验比较受体大鼠左、右侧移植物体积和重量。P<0.05为差异有统计学意义。 结果移植肝叶均为双右上叶。供肝重量和受体大鼠肝重量分别为(4.30±0.06)和(9.4±0.2)g,移植物与受体大鼠体质量、肝重量比分别为1.79%～1.88%、45.7%～46.8%。手术时间(70±4)min,冷缺血时间(30.0±1.5)min,热缺血时间(12.0±1.5)min,无肝期(20.0±2.5)min。6只受体大鼠双肝移植后1 d行磁共振检查,两侧移植物体积相同;术后15 d行磁共振检查,有3只发生单侧移植物萎缩。 结论大鼠双肝移植后部分受体一侧移植物会发生萎缩。     

成人间活体扩大右半肝移植治疗急性肝功能衰竭

目的介绍成人间活体扩大右半肝移植治疗急性肝功能衰竭的临床经验。方法对1例42岁男性急性肝功能衰竭合并肝性脑病Ⅲ期患者行活体扩大右半肝移植治疗。其45岁姐姐为供者,CT评估供者包含肝中静脉的扩大右半肝体积为728．4cm^2（801g）,供肝／受者体重比为1．3％。供肝之肝右、中静脉整形后与受者整形后之肝右静脉行端-侧吻合;供受者门静脉、肝动脉行端．端吻合。供肝胆管整形后与受者胆总管行端-端吻合。结果供、受者手术均成功。供者术后恢复顺利,受者术后8h恢复意识,14d后丙氨酸转氨酶、总胆红素等指标首次下降至正常水平。术后16d曾出现转氨酶明显升高,给予甲泼尼龙1000mg冲击治疗后恢复正常。随访至今,供受者已健康生存8个月,均未出现胆管、肝动脉及静脉回流等并发症。结论扩大右半肝移植在技术上完全可行。能为成人患者提供足够重量的移植物,尤其对于急性肝功能衰竭患者具有重要意义,术前精确的影像学评估,熟练的肝切除和肝移植技术是确保该类手术成功的关键因素。     

Liver Graft Regeneration in Right Lobe Adult Living Donor Liver Transplantation

Optimal portal flow is one of the essentials in adequate liver function, graft regeneration and outcome of the graft after right lobe adult living donor liver transplantation (ALDLT). The relations among factors that cause sufficient liver graft regeneration are still unclear. The aim of this study is to evaluate the potential predisposing factors that encourage liver graft regeneration after ALDLT. The study population consisted of right lobe ALDLT recipients from Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan. The records, preoperative images, postoperative Doppler ultrasound evaluation and computed tomography studies performed 6 months after transplant were reviewed. The volume of the graft 6 months after transplant divided by the standard liver volume was calculated as the regeneration ratio. The predisposing risk factors were compiled from statistical analyses and included age, recipient body weight, native liver disease, spleen size before transplant, patency of the hepatic venous graft, graft weight-to-recipient weight ratio (GRWR), posttransplant portal flow, vascular and biliary complications and rejection. One hundred forty-five recipients were enrolled in this study. The liver graft regeneration ratio was 91.2 ± 12.6% (range, 58–151). The size of the spleen (p = 0.00015), total portal flow and GRWR (p = 0.005) were linearly correlated with the regeneration rate. Patency of the hepatic venous tributary reconstructed was positively correlated to graft regeneration and was statistically significant (p = 0.017). Splenic artery ligation was advantageous to promote liver regeneration in specific cases but splenectomy did not show any positive advantage. Spleen size is a major factor contributing to portal flow and may directly trigger regeneration after transplant. Control of sufficient portal flow and adequate hepatic outflow are important factors in graft regeneration.     

成人间活体供肝移植中供肝的肝中静脉分配

目的 探讨成人间活体供肝移植中切取供者右半供肝(含或不含肝中静脉)的安全性及临床效果.方法 2007年6月至2008年9月,单小组实施成人间活体供肝切取手术78例;76例行右半供肝移植,其中供肝含肝中静脉30例(含肝中静脉组),不含肝中静脉46例(不含肝中静脉组).对两组供者的基本资料、手术相关资料以及术后肝功能恢复情况进行了评估和比较.结果 CT计算供者残留肝脏体积比为29.40%～50.99%;供肝重量与受者体重的比例(GRWR)为0.74%～1.76%.两组供者(含与不含肝中静脉组)在年龄、体重身高指数(BMI)、手术时间、术中失血量和输注红细胞量、拔除引流管时间、住院时间以及供者存活率方面比较,差异均无统计学意义;含肝中静脉组供者体重小于受者体重所占的比例(75.0%)明显高于不含肝中静脉组(40.0%),差异有统计学意义(P<0.05);含肝中静脉组切取的供肝重量、实际GRWR以及供肝冷保存时间明显低于不含肝中静脉组(P<0.05);两组供者术后肝功能恢复情况比较.差异无统计学意义.结论 供者经过严格的术前评估,切取含或不含肝中静脉的右半供肝均是安全的,临床效果满意.     

劈离式肝移植术后移植肝再生的研究

目的研究劈离式肝移植术后移植肝组织的再生规律。方法通过CT检查计算劈离式肝移植术后4例受体在不同时间点的肝体积变化,并检查患者移植术后肝功能。结果受体1术后4个月、1年时肝体积分别是标准体积的114%、97%,肝体积再生率为-11·0%、-24·3%;受体2术后4个月、1年肝体积分别是标准体积的96%、100%,肝体积再生率为24·4%、30·0%。受体3术后2个月肝体积是标准体积的86%,肝体积再生率为12·0%;受体4术后2个月肝体积是标准体积的90%,肝体积再生率为20·0%。4例受体术后肝功能均恢复正常。结论劈离式肝移植供肝有较强的再生能力,能满足受体的代谢需要。     

高龄供肝对肝移植术后并发症的影响——148例受者预后分析及思考

目的研究高龄供肝对肝移植术后移植物功能及受者生存率的影响及其干预策略。方法根据供者年龄≥或<60岁1:1配对选取2016年1月—2017年6月期间行肝移植手术患者为研究对象,分为高龄供者(elderly donor,ED,n=74)组和非高龄供者(non-elderly donor,NED,n=74)组。比较分析受者肝功能恢复情况、并发症、移植物及受者生存率。结果ED组移植物早期功能不全发生率为47.3%,显著高于NED组的28.4%(P=0.018);ED组胆道并发症发生率为21.6%,显著高于NED组的9.5%(P=0.041);ED组移植物存活率显著低于NED组(P=0.023)。ED组冷缺血时间>12 h者移植物早期功能不全发生率显著高于<12 h者(70.6%比40.4%,P=0.003)。结论高龄供肝的使用会影响移植物早期功能恢复及其1年存活率,缩短冷缺血时间可以显著降低EAD的发生率,改善受者预后。     

Whole liver versus split liver versus living donor in the adult recipient: an analysis of outcomes by graft type

BACKGROUND: We studied patient and graft survival rates in adult liver transplant recipients, analyzing outcomes based on donor source (deceased donor [DD] vs. living donor [LD]) and graft type (whole liver vs. partial liver). METHODS: A retrospective database analysis of all adult liver transpants performed at our center over a 7-year period of time. RESULTS: Between 1999 and 2005, 384 liver transplants were performed in adult recipients, either as a whole liver from a deceased donor (DD-WL, n=284), split liver from a DD (DD-SL, n=31), or a partial transplant from a living donor (LD, n=69). DD-SL transplants were performed with a full right or left lobe graft, while LD transplants used the right lobe. Demographic differences in the three groups were most noticeable for lower model for end-stage liver disease scores in LD recipients (P<0.001) and younger donor age in DD-SL recipients (P<0.001). Superior graft survival results were seen in LD recipients versus either DD-WL recipients or DD-SL recipients (P=0.02 and P=0.05, respectively). Multivariate analysis showed hepatitis C (HR=1.53, P=0.05) and hepatocellular carcinoma (HR=1.74, P=0.03) to be significant risk factors for patient survival. Hepatitis C (HR=1.61, P=0.03) and donor age more than 50 (HR=1.64, P=0.04) were significant risk factors for graft survival. However, neither graft type nor donor source were significant independent risk factors for patient or graft survival. CONCLUSIONS: Our data suggests that the status of the recipient is probably a more important determinant of outcome than graft type or donor source.     

公民逝世后器官捐献供肝移植62例临床分析

目的分析公民逝世后器官捐献供肝移植的流程方法及疗效,为公民逝世后器官捐献供肝移植提供一定借鉴。 方法回顾性分析中山大学附属中山医院2008年10月至2015年12月完成62例公民逝世后器官捐献肝移植病例的临床资料。 结果62例均符合《中国心脏死亡器官捐献工作指南》三类捐献标准（脑-心双死亡标准器官捐献,DBCD）。所有病例按标准成功完成了肝脏捐献及获取流程,其中15例使用体外膜肺氧合技术（ECMO）维持至器官获取。供肝热缺血时间0~30（16.2±6.5）min,冷缺血时间190~680（347±39）min。62例受体均顺利植入供肝,未出现原发性移植肝无功能、排斥反应。1例围手术期死于多发动脉血栓形成,1例发生胆漏经引流后自愈,2例发生胆道狭窄并发症,经胆道支架置入后缓解;肿瘤复发转移死亡3例。 结论通过合理流程充分利用ECMO,加强获取器官管理,缩短热冷缺血时间,公民逝世后器官捐献供肝移植可以获得较满意的临床效果。     

右半肝活体肝移植验证标准肝体积公式

目的 分析216例活体肝移植患者的临床资料,探讨适合中国成人活体肝移植肝体积评估标准.方法 华西医院移植中心2001年7月至今共实施216例活体肝移植,选取符合标准的成人间活体右半肝(不含肝中静脉)179例肝移植供体,将供体的术中实测右半肝体积与CT测量右半肝体积以及各公式计算的标准右半肝体积进行比较,评估哪种公式更适合中国成人.结果 CT测量右半肝体积大于实际右半肝体积(P＜0.01).德国Heinemann、美国Yoshizumi、日本Urata、美国Vauthey、韩国Lee公式计算的右半肝体积结果显著大于实际肝脏体积(P＜0.01).香港Sheung Tat 公式计算的右半肝体积结果小于实际肝脏体积,差异有统计学意义(P＜0.05).华西Lünan-yan公式计算的右半肝体积结果与实际肝脏体积比较差异无统计学意义(P＞0.05).结论 华西Lünan-yan 标准肝体积公式适合中国成人活体肝移植标准肝体积评估.     

Graft Selection Algorithm Based on Congestion Volume for Adult Living Donor Liver Transplantation

A major concern in adult‐to‐adult living donor liver transplantation is the selection of graft type; that is, is it is better to use the right lobe with or without the middle hepatic vein (MHV)? This choice has a considerable impact on donor safety, vascular reconstruction and graft function in the recipient. To facilitate making an appropriate choice, on the basis of a preliminary study (n = 17), we herein propose a graft selection algorithm using three parameters: graft‐to‐recipient body weight ratio (GRWR), percentage remnant liver volume (%RLV) and estimated congestion ratio (ECR). The algorithm was evaluated with 50 consecutive cases with respect to postoperative liver function of donors and recipients and survival of recipients. Postoperative recovery was comparable between the two groups (p = NS). The overall cumulative 18‐month survival rate was 86.7% for the ‘with MHV graft group’, and 76.1% for the gwithout MHV graft grouph (p = NS). For 41 cases (82%), graft types were chosen according to the algorithm, whereas the remaining 9 cases (18%) needed detailed discussion of donor, recipient and operative factors. In conclusion, we constructed a graft selection algorithm based on congestion volume, which will contribute to objective graft‐type selection in adult‐to‐adult LDLT .     

中叶供肝肝移植的可行性动物实验研究

目的：探索肝中叶作为独立供肝进行移植的可行性,以进一步拓宽供肝来源。
方法：普通级健康犬分成供体组（n=12,20~25 kg）和受体组（n=12,10~15 kg）,供受体随机配对。供体手术将位于中央区的方叶、右中叶在体内劈离,原位灌注后保留其专属的门静脉中支、肝中动脉和中肝管,得到独立的中央区供肝并称重。受体手术先建立临时性门腔分流,供肝背驮式植入,流出口和腔静脉壁端侧吻合,供肝门静脉中支和受体门静脉主干行端端吻合后恢复新肝血流,重建动脉和胆管。术后观察受体腹腔及胆汁引流,每日检测肝功能,死亡后行尸检,移植物取标本行病理检查。
结果：犬肝被深陷的叶间裂分隔成7叶,各叶间由较少的肝桥连接,方叶和右中叶由门静脉中支、中肝动脉营养血回流至肝中静脉,胆汁引流至中肝管。供体组体内劈离技术全部得以完成,手术时间（215.0±67.7）min,失血量（229.3±66.5）mL。比较GRWR,中央区供肝[（1.3±0.3）%]和假设的左侧区供肝的[（2.1±0.4）%]及右侧区供肝的[（0.9±0.1）%]之间差异均有统计学意义（均P<0.01）。受体组手术时间（327.6±75.3）min,无肝期（33.6±7.5）min,失血量（415.5±79.8）mL。12个供肝均成功植入,冷缺血时间为（41.9±12.1）min,（8.3±3.6）min后排泌胆汁。受体肝功能指标在术后第1天发生明显变化,随后逐渐恢复,中位存活时间92.5（18~272）h,未发现有因吻合口出血、血栓等外科技术性并发症而死亡受体。
结论：犬动物模型证实肝中央区可以劈离出来作为一个独立的供肝器官,为将来拓宽供肝来源提供了另外一种思路。     

吲哚菁绿试验联合二维剪切波弹性成像技术评估供肝质量价值初探

目的探讨吲哚菁绿(ICG)试验联合二维剪切波弹性成像(2D SWE)技术评估供肝质量的临床价值。 方法回顾性分析2018年5月至2018年11月于青岛大学附属医院器官移植中心完成脑死亡器官捐献的21例供受者临床资料。供肝获取前均于本院ICU完成ICG试验和2D SWE检查。根据受者移植术后早期肝功能恢复情况，将6例发生早期移植物功能不全受者列为观察组，将15例早期肝功能正常受者列为对照组。采用两独立样本t检验比较观察组与对照组受者年龄和移植前末次终末期肝病模型评分以及供肝冷缺血时间、吲哚菁绿15 min滞留率(ICG-R15)、吲哚菁绿血浆清除率(ICG-PDR)和杨氏模量值。采用Wilcoxon符号秩和检验比较两组受者移植前末次Child-Pugh评分和无肝期时间。采用受试者工作特征(ROC)曲线评价ICG试验、2D SWE及2D SWE联合ICG试验对肝移植受者术后发生早期移植物功能不全的预测效果。P<0.05为差异有统计学意义。 结果观察组和对照组受者平均年龄分别为(38±13)岁和(54±6)岁，差异有统计学意义(t＝2.840，P<0.05)。观察组与对照组供者供肝ICG-R15分别为(5.5±3.0)%和(3.2±1.4)%，差异有统计学意义(t＝－2.386，P<0.05)；ICG-PDR分别为(21±5)%/min和(24±4)%/min，杨氏模量值分别为(5.0±1.3)kPa和(3.9±2.6)kPa，差异均无统计学意义(t＝1.655和－0.930，P均>0.05)。ICG-R15预测肝移植术后发生早期移植物功能不全的ROC曲线下面积为0.767(95%CI：0.490～1.000，P>0.05)，ICG-PDR为0.789(95%CI：0.513～1.000，P<0.05)，2D SWE为0.756(95%CI：0.5392～0.9719，P>0.05)，ICG-R15联合ICG-PDR为0.767(95%CI：0.490～1.000，P>0.05)。ICG-R15及ICG-PDR联合2D SWE预测肝移植术后发生早期移植物功能不全的ROC曲线下面积为0.822(95%CI：0.608～1.000，P<0.05)，最佳阈值为ICG-R15＝4.15%，ICG-PDR＝21.7 %/min，杨氏模量值＝3.00 kPa，敏感度为83.3%，特异度为86.7%。 结论ICG试验联合2D SWE技术对肝移植术后早期移植物功能不全的预测优于2D SWE或ICG试验，且具有无创、简便和可定量评估等优势。     

受体血清“封闭”供肝预防异种肝移植超急性排斥反应

目的 探讨受体血清“封闭”供肝对异种肝移植超急性排斥反应(hyperacute rejection,HAR)的预防作用.方法 取豚鼠和SD大鼠各20只,分别作为供体和受体,供受体随机配对;移植前采集受体大鼠近交系其他个体血清,45℃水浴灭活补体备用;实验组(n=10)术前用0.1％受体血清(recipient serum,RS)的Ringer液“封闭”供肝,对照组(n=10)仅用Ringer液灌洗供肝;采用改良“双套管法”行豚鼠、SD大鼠原位肝移植,观察供肝植入后形态学改变、受体存活时间、术后1h存活率,HE染色法检测移植肝微血栓、出血和肝细胞水肿等病理损害积分;检测血清丙氨酸转氨酶(ALT)评价肝功能.结果 两组大鼠供体异种肝移植时间和无肝期比较,差异无统计学意义(P＞0.05);对照组受体大鼠供肝充盈缓慢,灌注不均,实验组供肝充盈迅速,灌注较均匀;实验组受体大鼠术后存活时间和术后1h存活率较对照组均明显增加(P＜0.01),移植肝微血栓、间质出血(积分)较对照组明显减轻(P＜0.01),肝细胞水肿无明显差异(P＞0.05);血清丙氨酸转氨酶(ALT)较对照组明显下降(P＜0.05).结论 受体血清“封闭”供肝对异种肝移植HAR具有一定的抑制作用,是预防器官移植HAR的潜在方法之一.     

Factors Affecting Graft Survival After Adult/Child Split-Liver Transplantation: Analysis of the UNOS/OPTN Data Base

When considering advocacy of split-liver transplantation, it is important to understand whether comparable outcomes can be achieved. The goal of this study was to identify donor and transplant characteristics predictive of comparable outcomes by risk factor analysis. Using the United Network for Organ Sharing/ Organ Procurement and Transplantation Network data base between January 1996 and May 2006, first time adult/child split cases (568 adults, 508 children) were examined. In multivariate analysis, recipient medical condition (hospitalization), status 1 assignment, ABO incompatibility, donor age (>40 years), donor body weight (≤40 kg), calculated whole graft volume to recipient body weight ratio (cGRWR ≤1.5%) and no sharing between centers were significant risk factors in adult recipients.
Recipient diagnosis of tumor, dialysis prior to transplant, recipient body weight (≤6 kg), donor age (>30 years), donor history of cardiac arrest after declaration of death and cold ischemia time (CIT > 6 h) increased the risk of graft failure in pediatric recipients. The livers from young donors showed comparable outcomes to whole deceased liver transplantation (LT) when other transplant-related risk factors were minimized in adult recipients. Reducing CIT is important to obtain comparable outcomes to living donor LT in pediatric recipients.     

儿童心脏死亡器官捐献供肝在成人受者肝移植中的应用(附1例报道)

目的探讨成人受者接受儿童心脏死亡器官捐献(DCD)供肝的受者选择标准、手术方式、常见并发症及处理方法。方法回顾性分析2011年我院完成的1例成人受者接受儿童DCD供肝移植病例的临床资料并进行文献复习。结果供者为6岁女性溺水儿童,心脏死亡后捐献肝脏,供肝重量598 g,热缺血时间10 min。受者体重55 kg,移植物受者体重比为1.09%,移植物体积/受者估计标准肝体积为61.8%。手术采用经典非转流术式,术后患者肝功能恢复顺利,术后第14天CT显示移植肝动、静脉未见异常,移植肝体积增至1 003 cm3,于术后45 d出院。术后3个月随访患者肝功能正常。结论儿童DCD供肝可以成功地应用于成人受者,但需要根据供肝情况选择合适的受者及手术方式。     

Impact of donor age and recipient status on left-lobe graft for living donor adult liver transplantation.

Donor safety is the priority when performing a living donor adult liver transplantation (LDALT). We herein present our findings using left-lobe graft in LDALT. Data on 119 recipients who underwent the LDALT, and on 119 donors who underwent extended left lobectomy were reviewed. The recipients were divided into groups above (n = 19) and below (n = 100) 50 years of donor age, into groups above (n = 63) and below (n = 56) 40% of graft size (graft volume/standard liver volume, GV/SLV), and above (n = 25) and below (n = 94) 20 of pre-operative model for end-stage liver disease (MELD). Total bilirubin (TB), volume of ascites, prothrombin time international normalized ratio on postoperative day 14 or survival rates were compared. TB (mg/dl) or volume of ascites (ml) of the group in donor age < 50 years was better than that of the group in donor age > or = 50 years (7.4 vs. 14.7 or 788 vs. 1379, P < 0.001 or P < 0.005, respectively). The graft and patient survival rates of the lower MELD group tended to be better than that of the higher MELD group. LDALT can be safely performed using a left-lobe graft. However, when using the graft from the donor > or = 50 years, especially for the recipients with the MELD > or = 20, the indications should be carefully discussed.     

Critical use of extended criteria donor liver grafts in adult-to-adult whole liver transplantation: a single-center experience.

This study presents our experience with the use of extended criteria donor (ECD) liver grafts. One hundred fifteen liver transplants were divided into 2 groups: standard (S) and nonstandard (NS). Fifty-eight patients in group S received a liver procured from an ideal donor, whereas 57 patients in group NS received an organ from an ECD. On the basis of the number of risk factors, patients were divided into 3 subgroups: the S group with 58 receiving a standard graft, the NS1 group with 44 receiving a graft with 1 or 2 risk factors, and the NS2 group with 13 receiving a graft with 3 to 4 risk factors. Patient survival was not different at 6, 12, and 24 months (P > 0.05), whereas graft survival was different (P = 0.0079). Both patient survival and graft survival were influenced by the cumulative number of risk factors. The univariate analysis of the donor risk factors detected hemodynamic factors as predictive of graft failure (P = 0.024) and death (P = 0.018). In the multivariate analysis, which was adjusted for recipient age and donor and recipient gender, hemodynamic risk factors and Model for End-Stage Liver. Disease score in the recipient were the only variables independently associated with graft failure (P = 0.006, P = 0.012, negatively). Finally, we observed a reduction of dropout from the list to 9% from 14.1% (P = 0.04) and of mortality on the list to 32.55% from 41.01% (P = 0.11). Critical use of ECD liver grafts allowed recipients in the waiting list to have a greater chance of being transplanted.     

Analysis of marginal donor parameters in liver transplantation for primary biliary cirrhosis

The shortage in cadaveric donor livers is pushing the transplant centers to expand the pool by using "marginal" donors. Primary biliary cirrhosis (PBC) remains an important indication for transplantation. We conducted a retrospective analysis of prospectively collected data in a well-defined group of patients with PBC where 301 consecutive donor-PBC recipient pairs transplanted were analyzed to identify donor and operative factors influencing recipient outcome. Mean follow-up was 56 months. The 1-, 3- and 5-year actuarial patient and graft survival was 93.97%, 90.64%, and 81.75%, and 85.49%, 82.57%, and 75.21%, respectively. Factors showing influence in decreased total patient survival were recipient old age (P = 0.003) and low recipient albumin (P = 0.01). However, the only variables showing an association with decreased patient survival within 90 days are old donor age (P = 0.002) and high donor body weight (P = 0.03) or high body mass index (BMI) (P = 0.055). Cold ischaemic time (CIT) of 18 hours showed statistical significance in patient survival (P = 0.025). Obesity did have a significant adverse impact on survival compared with normal or overweight donors (BMI < 30), decreasing survival by 50% at 5 years. In conclusion, this study of several factors considered "marginal" for transplantation in a recipient population with predictable liver disease (PBC), donor BMI and age were shown to be associated with decreased graft and patient survival.     

应用供者髂动脉行腹主动脉搭桥重建移植肝动脉的临床分析

目的探讨应用供者髂动脉行腹主动脉搭桥重建移植肝动脉对肝移植受者预后的影响。 方法回顾性分析中国医科大学附属第一医院2006年1月至2018年4月应用供者髂动脉行腹主动脉搭桥重建肝动脉的肝移植受者临床资料,观察其术后肝功能恢复情况及肝动脉血栓等并发症的发生情况,分析采用搭桥方式进行移植肝动脉重建的原因。 结果共纳入8例受者,其中1例存在脾动脉盗血综合征导致肝总动脉供血不足,3例肝总动脉纤细,4例肝总动脉壁薄弱或分层。重建后肝动脉平均血流为(315±178)mL/min。术后2例受者分别因肝脏流出道和胆管吻合口狭窄导致黄疸,其余受者移植肝功能恢复良好。1例受者术后2个月出现肝动脉血栓形成,继发肝脓肿,半年后因多脏器功能衰竭死亡。其余7例受者随访至2018年11月均存活,肝动脉均通畅,无狭窄或血栓形成。 结论当供、受者常规肝动脉端端吻合无法实施时,应用供者髂动脉行腹主动脉搭桥重建移植肝动脉是一种可行的肝动脉重建方法。