Application of donor liver with steatosis in adult split liver transplantation

doi:10.3877/cma.j.issn.2095-3232.2024120

Abstract

Abstract:

Objective

To evaluate the safety and clinical efficacy of donor livers with steatosis in adult split liver transplantation （SLT）.

Methods

Clinical data of 67 donors and recipients who underwent SLT in the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to January 2022 were retrospectively analyzed. The informed consents of all donors and recipients or （and） their families were obtained and the local ethical committee approval was received. 56 donors were male and 11 female，aged（33±13） years on average，and 60 donors were DBD and 7 cases were DCD. Among 67 recipients，51 cases were male and 16 female，with an average age of （51±12） years. Primary diseases included 24 cases of liver cirrhosis induced by viral hepatitis B （HBV） or viral hepatitis C （HCV），20 cases of malignant liver tumors，21 cases of liver failure and 2 cases of hereditary metabolic diseases，respectively. The median model for end-stage liver disease （MELD） score was 25（8-40）. After strict screening and matching of the donors and recipients，the donors with stable circulation were selected. The cold ischemia time （CIT） was shortened to ≤ 8 h. The serum sodium levels of the donors were maintained at ＜160 mmol/L. The process of donor liver splitting was optimized. According to the grading of donor liver steatosis，the recipients who were transplanted with corresponding donor livers were divided into the S0 group （degree of steatosis＜10%）and S1 group （degree of steatosis between 10% and 20%）. The recovery of liver allograft function，the incidence of perioperative complications and clinical prognosis were observed two groups. The incidence of early allograft dysfunction （EAD） at postoperative 7 d was compared with Chi-square test. Postoperative survival analysis was conducted by using Kaplan-Meier method and Log-rank test.

Results

In the S0 and S1 groups，the incidence of vascular complications was 6%（3/54） and 0，7%（4/54） and 8%（1/13）for biliary complications，and 13%（7/54） and 23%（3/13） for postoperative EAD，respectively，and no significant differences were observed between two groups （P＞0.05）. All 67 patients were followed up for 13-115 months，with a median follow-up time of 57 months. 6 patients died during postoperative follow-up，including 4 recipients in the S0 group and 2 in the S1 group. No patient died within postoperative 30 d in two groups. In the S0 group，the 1-year and 3-year survival rates of recipients were 98.1% and 92.4%，and 92.3% and 80.8% in the S1 group，with no statistical significance between two groups （χ²=0.726， P=0.394）.

Conclusions

Donor livers with a degree of steatosis of ＜10% can be used for SLT. For the donor livers with a degree of steatosis between 10% and 20%，SLT can be performed cautiously and safely in adult by means of liver splitting in vivo，CIT control，higher graft recipient weight ratio （GRWR） and strict recipient selection.

Key words: Steatotic Donor Livers, Split Liver Transplantation, Early Postoperative Liver Dysfunction

Binsheng Fu, Xiao Feng, Qing Yang, Kaining Zeng, Jia Yao, Hui Tang, Jianrong Liu, Xuxia Wei, Huimin Yi, Shuhong Yi, Guihua Chen, Yang Yang. Application of donor liver with steatosis in adult split liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 789-794.

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URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2024120

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Figures/Tables 3

组别	供者性别（例）		在体/离体劈离（例）		捐献分类（例）		供肝类型（例）			供者年龄（岁， $\overset{ˉ}{x}$ ±s）	受者年龄（岁， $\overset{ˉ}{x}$ ±s）	供者BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	男	女	在体	离体	DBD	DCD	右三叶	右半肝	左半肝	供者年龄（岁， $\overset{ˉ}{x}$ ±s）	受者年龄（岁， $\overset{ˉ}{x}$ ±s）	供者BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
S0组	45	9	14	40	48	6	47	6	1	32±13	51±13	22.5±2.9
S1组	11	2	8	5	12	1	7	5	1	37±10	51±8	24.7±4.5
统计值	-		-		-		-			t=-1.480	t=0.024	t=-2.237
P值	1.000		0.022		1.000		0.025			0.152	0.981	0.029
组别	受者BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	GRWR（%，x±s）	受者MELD评分（分， $\overset{ˉ}{x}$ ±s）	冷缺血时间（min， $\overset{ˉ}{x}$ ±s）	无肝期时间（min， $\overset{ˉ}{x}$ ±s）	温缺血时间（min， $\overset{ˉ}{x}$ ±s）	术中出血量［ml，M（Q₁，Q₃）］
S0组	23.3±3.1	1.50±0.23	27±10	401±103	49±9	59±32	1 500（950，3 000）
S1组	22.5±4.2	1.68±0.23	20±9	357±80	53±15	56±34	1 200（800，2 250）
统计值	t=0.778	t=-2.476	t=2.033	t=1.142	t=-1.212	t=0.225	Z=0.440
P值	0.440	0.017	0.046	0.163	0.230	0.823	0.665

组别	供者性别（例）		在体/离体劈离（例）		捐献分类（例）		供肝类型（例）			供者年龄（岁， $\overset{ˉ}{x}$ ±s）	受者年龄（岁， $\overset{ˉ}{x}$ ±s）	供者BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	男	女	在体	离体	DBD	DCD	右三叶	右半肝	左半肝	供者年龄（岁， $\overset{ˉ}{x}$ ±s）	受者年龄（岁， $\overset{ˉ}{x}$ ±s）	供者BMI（kg/m²， $\overset{ˉ}{x}$ ±s）
S0组	45	9	14	40	48	6	47	6	1	32±13	51±13	22.5±2.9
S1组	11	2	8	5	12	1	7	5	1	37±10	51±8	24.7±4.5
统计值	-		-		-		-			t=-1.480	t=0.024	t=-2.237
P值	1.000		0.022		1.000		0.025			0.152	0.981	0.029
组别	受者BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	GRWR（%，x±s）	受者MELD评分（分， $\overset{ˉ}{x}$ ±s）	冷缺血时间（min， $\overset{ˉ}{x}$ ±s）	无肝期时间（min， $\overset{ˉ}{x}$ ±s）	温缺血时间（min， $\overset{ˉ}{x}$ ±s）	术中出血量［ml，M（Q₁，Q₃）］
S0组	23.3±3.1	1.50±0.23	27±10	401±103	49±9	59±32	1 500（950，3 000）
S1组	22.5±4.2	1.68±0.23	20±9	357±80	53±15	56±34	1 200（800，2 250）
统计值	t=0.778	t=-2.476	t=2.033	t=1.142	t=-1.212	t=0.225	Z=0.440
P值	0.440	0.017	0.046	0.163	0.230	0.823	0.665

组别	例数	血管并发症	胆道并发症	EAD
S0组	54	3	4	7
S1组	13	0	1	3
χ ²值		-	-	-
P值		＞0.999	＞0.999	0.394

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