活体肝移植中轻度脂肪变性供肝的应用

摘要

背景:在活体肝移植中使用脂肪变性供肝不但影响供者的安全,同时也影响受者的生存.目的:评价活体肝移植中使用轻度脂肪变性供肝时供者的安全性及受者预后情况.方法:回顾性分析104 例成人间右半肝活体肝移植的资料,根据移植过程中供肝活检病理标本的脂肪变性程度将所有病例分成4 个组.比较各组移植供受者移植后2 周的肝体积增生率,分析104 例成人间活体右半肝肝移植受者移植后死亡情况及原因.结果与结论:4 组病例在供受者移植后肝功能的恢复和受者后移植预后无明显差别,没有肝功能延迟恢复和原发无功发生.轻度大泡性脂肪肝者只要残肝足够可以成为合适的活体肝移植供者.使用轻度大泡性脂肪肝并不增加受者病死率和移植物失功.%BACKGROUND: Steatotic liver graft transplantation affects donor safety as well as recipient survival in living related liver transplantation (LRLT).OBJECTIVE: To assess safety of donors of steatotic liver and prognosis of steatotic liver grafts' recipients in LRLT.METHODS: We retrospectively reviewed 104 cases of LRLT, dividing them into 4 groups according to degree of macrovesicular fatty change upon intraoperative liver biopsy. The degree of macrovesicular steatosis was compared among four groups, and death cause was analyzed among 104 cases undergoing right liver transplantation.RESULTS AND CONCLUSION: There was no statistically significant difference in postoperative hepatic function recovery of donors and recipients among four groups. Overall recipients' prognosis was not different among the groups. No primary graft nonfunction (PNF) or delayed graft function (DGF) occurred. Mild macrovesicular steatotic livers may be good donor candidates without significant complications as long as sufficient residual liver volume is left for the donor. Mild macrovesicular steatotic graft did not increase the risk of graft dysfunction or morbidity in LRLT