Альманах клинической медицины. 2020; 48: 162-170
Сплит-трансплантация печени: опыт одного центра
https://doi.org/10.18786/2072-0505-2020-48-031Аннотация
Актуальность. Сплит-трансплантация печени – широко применяемый в мире метод, позволяющий увеличить пул донорских органов, в особенности для реципиентов детского возраста. Важными вопросами остаются селекция доноров, отдельные технические аспекты, а также отдаленные результаты сплит-трансплантации.
Цель – анализ собственных клинических результатов сплит-трансплантации печени, принципов селекции посмертных доноров и особенностей хирургической техники.
Материал и методы. С мая 2008 по декабрь 2019 г. было выполнено 32 разделения печени посмертного донора для трансплантации двум реципиентам (64 сплит-трансплантации печени). В 30 случаях печень разделяли на левую латеральную секцию и расширенную правую долю («классический» сплит), в двух случаях – на анатомическую левую и правую долю («полное разделение», англ. full split). В 22 случаях трансплантат разделяли in situ, в 10 – ex situ.
Результаты. Для реципиентов левосторонних трансплантатов (левая латеральная секция и левая доля печени) одно-, трех- и пятилетняя выживаемость составила 80, 80 и 60% соответственно. Для реципиентов правосторонних трансплантатов (расширенная правая доля печени и правая доля печени) аналогичный показатель был равен 93,3, 89,4 и 89,4% соответственно (p = 0,167). К наиболее вероятным факторам риска летальности, согласно результатам однофакторного анализа, относятся ретрансплантация печени (p = 0,047) и масса тела пациента (p = 0,04).
Заключение. При выполнении сплит-трансплантации целесообразно рассматривать доноров с высоким качеством паренхимы печени. Данная методика демонстрирует удовлетворительные результаты и может быть признана эффективной для оказания помощи пациентам с терминальными заболеваниями печени.
Список литературы
1. Hackl C, Schmidt KM, Süsal C, Döhler B, Zidek M, Schlitt HJ. Split liver transplantation: Current developments. World J Gastroenterol. 2018;24(47): 5312–21. doi: 10.3748/wjg.v24.i47.5312.
2. Bismuth H. Revisiting liver anatomy and terminology of hepatectomies. Ann Surg. 2013;257(3): 383–6. doi: 10.1097/SLA.0b013e-31827f171f.
3. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12(5): 351–5. doi: 10.1007/s00534-005-0999-7.
4. Rogiers X. Split-Liver Transplantation. In: Oniscu GC, Forsythe JLR, Pomfret EA, eds. Transplantation Surgery. Springer Surgery Atlas Series. Berlin, Heidelberg: Springer-Verlag; 2019. p. 355–65. doi: 10.1007/978-3-540-73796-4_15.
5. Латыпов РА. Сплит-трансплантация печени: дис. ... канд. мед. наук. М; 2019. 125 c.
6. de Ville de Goyet J, di Francesco F, Sottani V, Grimaldi C, Tozzi AE, Monti L, Muiesan P. Splitting livers: Trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes. Pediatr Transplant. 2015;19(5): 517–26. doi: 10.1111/petr.12534.
7. Angelico R, Trapani S, Spada M, Colledan M, de Ville de Goyet J, Salizzoni M, De Carlis L, Andorno E, Gruttadauria S, Ettorre GM, Cescon M, Rossi G, Risaliti A, Tisone G, Tedeschi U, Vivarelli M, Agnes S, De Simone P, Lupo LG, Di Benedetto F, Santaniello W, Zamboni F, Mazzaferro V, Rossi M, Puoti F, Camagni S, Grimaldi C, Gringeri E, Rizzato L, Nanni Costa A, Cillo U. A national mandatory – split liver policy: A report from the Italian experience. Am J Transplant. 2019;19(7): 2029–43. doi: 10.1111/ajt.15300.
8. Kwong A, Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Noreen SM, Foutz J, Miller E, Snyder JJ, Israni AK, Kasiske BL. OPTN/ SRTR 2018 Annual Data Report: Liver. Am J Transplant. 2020;20 Suppl s1:193–299. doi: 10.1111/ajt.15674.
9. Blok JJ, de Boer JD, Putter H, Rogiers X, Guba MO, Strassburg CP, Samuel U, van Hoek B, Hamming JF, Braat AE; Eurotransplant Liver Intestine Advisory Committee. The center effect in liver transplantation in the Eurotransplant region: a retrospective database analysis. Transpl Int. 2018;31(6): 610–9. doi: 10.1111/tri.13129.
10. Perito ER, Roll G, Dodge JL, Rhee S, Roberts JP. Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement. Transplantation. 2019;103(3): 552–7. doi: 10.1097/TP.0000000000002249.
11. Valentino PL, Emre S, Geliang G, Li L, Deng Y, Mulligan D, Rodriguez-Davalos MI. Frequency of whole-organ in lieu of split-liver transplantation over the last decade: Children experienced increased wait time and death. Am J Transplant. 2019;19(11): 3114–23. doi: 10.1111/ajt.15481.
12. Reyes J, Gerber D, Mazariegos GV, Casavilla A, Sindhi R, Bueno J, Madariaga J, Fung JJ. Split-liver transplantation: a comparison of ex vivo and in situ techniques. J Pediatr Surg. 2000;35(2): 283–9; discussion 289–90. doi: 10.1016/s0022-3468(00)90026-5.
13. Herden U, Fischer L, Sterneck M, Grabhorn E, Nashan B. Long-term follow-up after full-split liver transplantation and its applicability in the recent transplant era. Clin Transplant. 2018;32(3):e13205. doi: 10.1111/ctr.13205.
14. Camagni S, Colledan M. Full-Left Full-Right Split Liver Transplantation. In: Cillo U, De Carlis L, eds. Liver Transplantation and Hepatobiliary Surgery. Updates in Surgery. Cham: Springer Nature; 2020. p. 115–22. doi: 10.1007/978-3-030-19762-9_12.
15. Gundlach M, Broering D, Topp S, Sterneck M, Rogiers X. Split-cava technique: liver splitting for two adult recipients. Liver Transpl. 2000;6(6): 703–6. doi: 10.1053/jlts.2000.18503.
16. Humar A, Khwaja K, Sielaff TD, Lake JR, Payne WD. Split-liver transplants for two adult recipients: technique of preservation of the vena cava with the right lobe graft. Liver Transpl. 2004;10(1): 153–5. doi: 10.1002/lt.20019.
17. Bourdeaux C, Brunati A, Janssen M, de Magnée C, Otte JB, Sokal E, Reding R. Liver retransplantation in children. A 21-year single-center experience. Transpl Int. 2009;22(4): 416–22. doi: 10.1111/j.1432-2277.2008.00807.x.
18. Gavriilidis P, Azoulay D, Sutcliffe RP, Roberts KJ. Split versus living-related adult liver transplantation: a systematic review and meta-analysis. Langenbecks Arch Surg. 2019;404(3):285–92. doi: 10.1007/s00423-019-01771-4.
Almanac of Clinical Medicine. 2020; 48: 162-170
Split liver transplantation: a single center experience
https://doi.org/10.18786/2072-0505-2020-48-031Abstract
Background: Split liver transplantation is used worldwide and allows for an increase of donor organ pool, especially for pediatric recipients. Donor selection, some aspects of surgical techniques and long-term results remain to be important issues of split liver transplantation.
Aim: To analyze our own clinical results of split liver transplantation, basic principles of deceased donor selection and specifics of surgical technique.
Materials and methods: From May 2008 to December 2019, 32 cases of division of the deceased donor liver for transplantation to two recipients have been performed (64 split liver transplantations). Liver was divided into the left lateral section and the extended right lobe in 30 cases (“classical split”), and into the left lobe and right lobe in two cases (“full-split”). In 22 cases, the liver grafts were split in situ and in 10, ex-situ.
Results: In the recipients of left-side transplants (left lateral section and whole left lobe), the one-, three-, and five-year survival rates were 80, 80, and 60%, respectively. In the right-sided transplant recipients (extended right lobe and right lobe), the one-, three-, and five-year survival rates were 93.3, 89.4, and 89.4%, respectively (p = 0.167). The most probable risk factors for mortality in the univariate analysis were liver retransplantation (p = 0.047) and patient’s weight (p = 0.04).
Conclusion: For split transplantation, it is advisable to consider donors with a high-quality liver. This technique demonstrates satisfactory results and can be viewed as effective for patients with terminal liver diseases.
References
1. Hackl C, Schmidt KM, Süsal C, Döhler B, Zidek M, Schlitt HJ. Split liver transplantation: Current developments. World J Gastroenterol. 2018;24(47): 5312–21. doi: 10.3748/wjg.v24.i47.5312.
2. Bismuth H. Revisiting liver anatomy and terminology of hepatectomies. Ann Surg. 2013;257(3): 383–6. doi: 10.1097/SLA.0b013e-31827f171f.
3. Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005;12(5): 351–5. doi: 10.1007/s00534-005-0999-7.
4. Rogiers X. Split-Liver Transplantation. In: Oniscu GC, Forsythe JLR, Pomfret EA, eds. Transplantation Surgery. Springer Surgery Atlas Series. Berlin, Heidelberg: Springer-Verlag; 2019. p. 355–65. doi: 10.1007/978-3-540-73796-4_15.
5. Latypov RA. Split-transplantatsiya pecheni: dis. ... kand. med. nauk. M; 2019. 125 c.
6. de Ville de Goyet J, di Francesco F, Sottani V, Grimaldi C, Tozzi AE, Monti L, Muiesan P. Splitting livers: Trans-hilar or trans-umbilical division? Technical aspects and comparative outcomes. Pediatr Transplant. 2015;19(5): 517–26. doi: 10.1111/petr.12534.
7. Angelico R, Trapani S, Spada M, Colledan M, de Ville de Goyet J, Salizzoni M, De Carlis L, Andorno E, Gruttadauria S, Ettorre GM, Cescon M, Rossi G, Risaliti A, Tisone G, Tedeschi U, Vivarelli M, Agnes S, De Simone P, Lupo LG, Di Benedetto F, Santaniello W, Zamboni F, Mazzaferro V, Rossi M, Puoti F, Camagni S, Grimaldi C, Gringeri E, Rizzato L, Nanni Costa A, Cillo U. A national mandatory – split liver policy: A report from the Italian experience. Am J Transplant. 2019;19(7): 2029–43. doi: 10.1111/ajt.15300.
8. Kwong A, Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Noreen SM, Foutz J, Miller E, Snyder JJ, Israni AK, Kasiske BL. OPTN/ SRTR 2018 Annual Data Report: Liver. Am J Transplant. 2020;20 Suppl s1:193–299. doi: 10.1111/ajt.15674.
9. Blok JJ, de Boer JD, Putter H, Rogiers X, Guba MO, Strassburg CP, Samuel U, van Hoek B, Hamming JF, Braat AE; Eurotransplant Liver Intestine Advisory Committee. The center effect in liver transplantation in the Eurotransplant region: a retrospective database analysis. Transpl Int. 2018;31(6): 610–9. doi: 10.1111/tri.13129.
10. Perito ER, Roll G, Dodge JL, Rhee S, Roberts JP. Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement. Transplantation. 2019;103(3): 552–7. doi: 10.1097/TP.0000000000002249.
11. Valentino PL, Emre S, Geliang G, Li L, Deng Y, Mulligan D, Rodriguez-Davalos MI. Frequency of whole-organ in lieu of split-liver transplantation over the last decade: Children experienced increased wait time and death. Am J Transplant. 2019;19(11): 3114–23. doi: 10.1111/ajt.15481.
12. Reyes J, Gerber D, Mazariegos GV, Casavilla A, Sindhi R, Bueno J, Madariaga J, Fung JJ. Split-liver transplantation: a comparison of ex vivo and in situ techniques. J Pediatr Surg. 2000;35(2): 283–9; discussion 289–90. doi: 10.1016/s0022-3468(00)90026-5.
13. Herden U, Fischer L, Sterneck M, Grabhorn E, Nashan B. Long-term follow-up after full-split liver transplantation and its applicability in the recent transplant era. Clin Transplant. 2018;32(3):e13205. doi: 10.1111/ctr.13205.
14. Camagni S, Colledan M. Full-Left Full-Right Split Liver Transplantation. In: Cillo U, De Carlis L, eds. Liver Transplantation and Hepatobiliary Surgery. Updates in Surgery. Cham: Springer Nature; 2020. p. 115–22. doi: 10.1007/978-3-030-19762-9_12.
15. Gundlach M, Broering D, Topp S, Sterneck M, Rogiers X. Split-cava technique: liver splitting for two adult recipients. Liver Transpl. 2000;6(6): 703–6. doi: 10.1053/jlts.2000.18503.
16. Humar A, Khwaja K, Sielaff TD, Lake JR, Payne WD. Split-liver transplants for two adult recipients: technique of preservation of the vena cava with the right lobe graft. Liver Transpl. 2004;10(1): 153–5. doi: 10.1002/lt.20019.
17. Bourdeaux C, Brunati A, Janssen M, de Magnée C, Otte JB, Sokal E, Reding R. Liver retransplantation in children. A 21-year single-center experience. Transpl Int. 2009;22(4): 416–22. doi: 10.1111/j.1432-2277.2008.00807.x.
18. Gavriilidis P, Azoulay D, Sutcliffe RP, Roberts KJ. Split versus living-related adult liver transplantation: a systematic review and meta-analysis. Langenbecks Arch Surg. 2019;404(3):285–92. doi: 10.1007/s00423-019-01771-4.
