深入评估非肝硬化患者 RAPID 型辅助肝移植的临床、血流动力学和容积;我们只是在处理 ALPPS 移植模型吗?

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-11-01 Epub Date: 2024-08-07 DOI:10.1097/SLA.0000000000006475
Laurent Coubeau, Alix Fontaine, Olga Ciccarelli, Eliano Bonaccorsi, Max Derudder, Géraldine Dahqvist, Lancelot Marique, Raymond Reding, Isabelle A Leclercq, Alexandra Dili
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引用次数: 0

摘要

背景:RAPID(Resection And Partial Liver Transplantation with Delayed Total Hepatectomy,延迟全肝切除和部分肝移植)手术包括左肝切除、左叶正位植入和右门静脉结扎。这种技术可诱导移植物体积增大,从而在 15 天内完成右肝切除术。值得注意的是,目前还缺乏有关小尺寸(SFS)移植物暴露于门静脉溢流而不会引发 SFS 综合征的血液动力学数据:方法:一项前瞻性单中心方案包括 8 名活体供体和 8 名 RAPID 非肝硬化受体。收集了全面的临床和生物学数据,并进行了术中动脉和门静脉血流及压力测量。术后第 7 天和第 14 天,使用 CT 和 99Tc-mebrofenin 闪烁扫描评估早期动能生长率(eKGR%)和移植物功能。研究结果与13例左侧活体肝移植(LDLT)受者的回顾性数据进行了比较:中位移植物体重比为 0.41%(IQR,0.34 至 0.49),明显低于 LDLT。然而,RAPID和LDLT移植物的eKGR没有明显差异。序列分析显示,每天的 eKGR 有所不同:移植后第一周为 10.6%(7.8-13.2),第二周为 7.6%(6-9.1)。与左侧 LDLT 相比,RAPID 的指数门脉流量(iQpv)明显更高(P=0.01)。没有发现血液动力学参数与再生速度相关。我们对 8 个病例中的 2 个进行了门脉流量调节:本研究首次报告了RAPID技术的血液动力学和体积数据。尽管最初的移植物体积低于传统 LDLT 的推荐值,但该研究强调了可接受的临床结果。
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In-depth Clinical, Hemodynamic, and Volumetric Assessment of the Resection and Partial Liver Transplantation With Delayed Total Hepatectomy-Type Auxiliary Liver Transplantation in Noncirrhotic Setting: Are We Simply Dealing With a Transplant Model of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy?

Background: The Resection And Partial Liver Transplantation with Delayed total hepatectomy (RAPID) procedure involves left hepatectomy with orthotopic implantation of a left lobe and right portal vein ligation. This technique induces volumetric graft increase, allowing for a right completion hepatectomy within 15 days. Notably, there is a lack of data on the hemodynamics of small-for-size grafts exposed to portal overflow without triggering small-for-size syndrome.

Methods: A prospective single-center protocol included 8 living donors and 8 RAPID noncirrhotic recipients. Comprehensive clinical and biological data were collected, accompanied by intraoperative arterial and portal flow and pressure measurements. Early kinetic growth rate (eKGR%) and graft function were assessed using computed tomography and 99Tc-mebrofenin scintigraphy on postoperative days 7 and 14. Findings were compared with retrospective data from 13 left living donor liver transplantation (LDLT) recipients.

Results: The median Graft-body weight ratio was 0.41% (interquartile range: 0.34-0.49), markedly lower than in LDLT. However, there was no significant difference in eKGR between RAPID and LDLT grafts. Sequential analysis revealed variable eKGR per day: 10.6% (7.8-13.2) in the first week and 7.6% (6-9.1) in the second week posttransplantation. Indexed portal flow (indexed portal vein flow) was significantly higher in RAPID compared with left LDLT ( P = 0.01). No hemodynamic parameters were found to correlate with regeneration speed. We modulated portal flow in 2 out of 8 cases.

Conclusions: This study presents the first report of hemodynamic and volumetric data for the RAPID technique. Despite initial graft volumes falling below conventional LDLT recommendations, the study highlights acceptable clinical outcomes.

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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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