Risk of venous congestion in live donors of extended right liver graft

查看全文 作　　者：Arnold [1]Radtke;George [2]Sgourakis;Ernesto P [3]Molmenti;Susanne [4]Beckebaum;Vito R [4]Cicinnati;Hartmut [5]Schmidt;Heinz-Otto [6]Peitgen;Christoph E [4]Broelsch;Massimo [7]Malagó;Tobias [8]Schroeder

机构地区：[1]Department of General and Transplantation Surgery, University Hospital Tuebingen;[2]Department of General Surgery of Red Cross Hospital;[3]Department of Surgery, North Shore University Hospital, Manhasset;[4]Department of General, Visceral, and Transplantation Surgery,University Hospital Essen;[5]Department of Transplant Medicine,University Hospital Muenster;[6]MeVis Center for Medical Diagnostic Systems and Visualization, University of Bremen;[7]Department of Surgery-UCL Division of Surgical and Interventional Sciences, University College London;[8]Department of Diagnostic and Interventional Radiology, University Hospital Essen

出　　处：《World Journal of Gastroenterology》索引2015年第21卷第19期,共10页

基　　金：Supported by German Society for Research,No.117/1-1:A2.2 摘　　要：AIM: To investigate middle hepatic vein(MHV)management in adult living donor liver transplantation and safer remnant volumes(RV).METHODS: There were 59 grafts with and 12 grafts without MHV(including 4 with MHV-5/8 reconstructions).All donors underwent our five-step protocol evaluation containing a preoperative protocol liver biopsy Congestive vs non-congestive RV, remnantvolumebody-weight ratios(RVBWR) and postoperative outcomes were evaluated in 71 right graft living donors. Dominant vs non-dominant MHV anatomy in total liver volume(d-MHV/TLV vs nd-MHV/TLV) was constellated with large/small congestion volumes(CVindex).Small for size(SFS) and non-SFS remnant considerations were based on standard cut-off- RVBWR and RV/TLV. Non-congestive RVBWR was based on non-congestive RV.RESULTS: MHV and non-MHV remnants showed no significant differences in RV, RV/TLV, RVBWR, total bilirubin, or INR. SFS-remnants with RV/TLV < 30%and non-SFS-remnants with RV/TLV ≥ 30% showedno significant differences either. RV and RVBWR for non-MHV(n = 59) and MHV-containing(n = 12)remnants were 550 ± 95 ml and 0.79 ± 0.1 ml vs568 ± 97 ml and 0.79 ± 0.13, respectively(P = 0.423 and P = 0.919. Mean left RV/TLV was 35.8% ± 3.9%.Non-MHV(n = 59) and MHV-containing(n = 12)remnants(34.1% ± 3% vs 36% ± 4% respectively,P = 0.148. Eight SFS-remnants with RVBWR < 0.65 had a significantly smaller RV/TLV than 63 non-SFSremnants with RVBWR ≥ 0.65 [SFS: RV/TLV 32.4%(range: 28%-35.7%) vs non-SFS: RV/TLV 36.2%(range: 26.1%-45.5%), P < 0.009. Six SFS-remnants with RV/TLV < 30% had significantly smaller RVBWR than 65 non-SFS-remnants with RV/TLV ≥ 30%(0.65(range: 0.6-0.7) vs 0.8(range: 0.6-1.27), P < 0.01.Two(2.8%) donors developed reversible liver failure.RVBWR and RV/TLV were concordant in 25%-33%of SFS and in 92%-94% of non-SFS remnants. MHV management options including complete MHV vs MHV-4A selective retention were necessary in n = 12 vs n =2 remnants based on particularly risky congestive and non-congestive volume constellations.CONCLUSION: MHV procurement should consider individual remnant congestive- and non-congestive volume components and anatomy characteristics,RVBWR-RV/TLV constellation enables the identification of marginally small remnants. 关键词：LIVING DONOR liver TRANSPLANTATION Livervolume REMNANT volume Small-for-size Small-forsizesyndrome

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Risk of venous congestion in live donors of extended right liver graft

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