Abstract：
Introduction: Small-for-size graft and consequently small-for-size syndrome (SFSS) is an important issue for adult living donor liver transplantation (LDLT). The optimal intra- and postoperative prevention and management strategies for SFSS remain unclear. We aimed to analyse and compare the existing strategies of portal inflow modulation (PIM) and conduct a meta-analysis of studies comparing various PIMs. The primary outcome was the incidence SFSS. Methods: The Google Scholar, Embase, PubMed, and Cochrane Library databases were systematically searched. Both fixed-and random-effects models were used to perform the meta-analysis. Results: Twenty-five studies were selected from a pool of 830 studies, of which 13 compared available surgical techniques between cohorts with and without PIM, and 12 reported outcomes of patients who underwent LDLT and developed SFSS. The incidence rate of SFSS was significantly lower in the PIM cohort than in the non-portal inflow modulation (NPIM) cohort. One-year overall survival (OS) and the re-transplantation rate were significantly better in the PIM cohort than in the NPIM cohort. Conclusion: In LDLT patients diagnosed during the reperfusion period with increased portal venous pressure and/or flow, application of PIM significantly decreased the incidence rate of SFSS and demonstrated significantly better one-year OS.
摘要：
简介：小尺寸移植物和因此小尺寸综合征（SFSS）是成人活体肝移植（LDLT）的重要问题。SFSS的最佳术中和术后预防和管理策略尚不清楚。我们旨在分析和比较现有的门静脉流入调节（PIM）的策略，并对比较各种PIM的研究进行荟萃分析。主要结果是SFSS的发生率。方法：谷歌学者，Embase,PubMed,系统检索了Cochrane图书馆数据库。使用固定效应和随机效应模型进行荟萃分析。结果：从830项研究中选择了25项研究，其中13个比较了有和没有PIM的队列之间的可用手术技术，12例报告了接受LDLT和SFSS的患者的结局。PIM队列中SFSS的发生率显着低于非门静脉流入调节（NPIM）队列。PIM队列的一年总生存率（OS）和再移植率明显优于NPIM队列。结论：在再灌注期诊断为门静脉压力和/或流量增加的LDLT患者中，PIM的应用显著降低了SFSS的发生率，并显示出显著改善的1年OS。
