Significance of Proper Graft Selection in Adult Living-Donor Liver Transplant Recipients with Preoperative Deteriorated Condition

被引：4

作者：

Iida, Taku ^{[1
,2
]}

Masuda, Koji ^{[1
]}

Matsuyama, Takehisa ^{[1
]}

Harada, Shunpei ^{[1
]}

Nakamura, Tsukasa ^{[1
]}

Koshino, Katsuhiro ^{[1
]}

Suzuki, Tomoyuki ^{[1
]}

Nobori, Shuji ^{[1
]}

Ushigome, Hidetaka ^{[1
]}

Ito, Takashi ^{[1
,2
]}

Sakamoto, Seisuke ^{[1
,2
]}

Uryuhara, Kenji ^{[1
,2
]}

Okajima, Hideaki ^{[1
,2
]}

Kaihara, Satoshi ^{[1
,2
]}

Uemoto, Shinji ^{[2
]}

Yoshimura, Norio ^{[1
]}

机构：

[1] Kyoto Prefectural Univ Med, Dept Organ Transplantat & Gen Surg, Kyoto, Kyoto, Japan

[2] Kyoto Univ, Div Hepatobiliary Pancreat Surg & Transplantat, Dept Surg, Kyoto, Kyoto, Japan

来源：

ANNALS OF TRANSPLANTATION | 2017年 / 22卷

关键词：

Graft Survival; Liver Transplantation; Transplantation; MELD SCORE; HOSPITAL MORTALITY; SINGLE-CENTER; IMPACT; SURVIVAL; OUTCOMES; INFECTIONS; EXPERIENCE; ALLOCATION; PRESSURE;

D O I：

10.12659/AOT.904575

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: The outcome of living-donor liver transplantation (LDLT) is poor for recipients with severely deteriorated preoperative condition. This study therefore evaluated the proper graft selection according to the recipients' preoperative condition. Material/Methods: We evaluated the clinical outcomes in 66 patients who underwent adult LDLT from October 2003 to June 2016 in our institution, excluding fulminant liver failure and ABO-incompatible cases. Preoperative risk factors included MELD score > 20, preoperative hospitalization for over 2 weeks or intensive care unit admission and bacterial infection within 1 month before LDLT. Patients were classified into those with 0-1 risk factors (Group LR, n=44) and those with 2-3 risk factors (Group HR, n=22). Results: The overall survival (OS) rate after LDLT was significantly lower in Group HR than in Group LR (1-year: HR 83.9% vs. LR 93%, 3-year: HR 70.8% vs. LR 90.5%, 5-year: HR 62% vs. LR 87.6%; p=0.029). In Group LR, OS rates did not differ significantly by graft type or donor age. In Group HR, OS rates at 1 (93.8% vs. 66.7%), 3 (85.2% vs. 50%), and 5 (75.8% vs. 25%) years were significantly higher using right (n=16) vs. left (n=6) lobe grafts (p=0.046). Conclusions: Proper graft selection is very important to improve the outcome of LDLT recipients in deteriorated preoperative condition. LDLT using right-lobe grafts may be recommended for high-risk severely deteriorated patients.

引用

页码：541 / 549

页数：9

共 30 条

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