未经批准:肝移植物短缺继续恶化。因为扩大使用小型移植物(SFSGs)将大大缓解这种短缺,我们旨在分析在慢性肝病(CLD)患者中使用SFSGs辅助肝移植(ALT)的现有知识,以确定CLD患者使用SFSGs发展ALT的机会。
UNASSIGNED:这是CLD患者使用SFSGs对ALT的系统评价。审查是通过从保留报告的作者那里获得的最新信息完成的。
UNASSIGNED:在1980年至2017年之间对26例患者进行了异位ALT,对于严格意义的SFGS均未进行,辅助部分原位肝移植(APOLT)27例(1999年至2021年),都是为了SFSG。在APOLT案例中,在大多数情况下进行了部分天然肝切除术,而第二阶段残余天然肝切除术仅在9例中进行。移植物体重的中位数为0.55,16例需要围手术期或术中门静脉调制。移植后24例患者至少发生1例并发症(发病率,89%)。4例患者(4/27,15%)在APOLT手术后死亡。从长远来看,19例(70%)患者在13个月至24年期间存活良好(中位数,4.5年),包括18例APOLT移植物到位,1例再次移植。
未经证实:尽管术后发病率高,和高度报道的技术可变性,APOLT技术是一种在CLD患者中使用SFSGs的有前途的技术,取得令人满意的长期成果。结果需要在更大范围内得到证实,标准化的技术可以带来更好的结果。
未经评估:以术后高发病率为代价,APOLT对小型移植物的长期效果良好。仍然需要程序和入口调制的标准化。
UNASSIGNED: The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic liver disease (CLD) to identify opportunities to develop ALT with SFSGs in patients with CLD.
UNASSIGNED: This is a systematic
review on ALT using SFSGs in patients with CLD. The
review was completed by updates obtained from the authors of the retained reports.
UNASSIGNED: Heterotopic ALT was performed in 26 cases between 1980 and 2017, none for SFGS stricto sensu, and auxiliary partial orthotopic liver transplantation (APOLT) in 27 cases (from 1999 to 2021), all for SFSG. In APOLT cases, partial native liver resection was performed in most of cases, whereas the second-stage remnant native liver hepatectomy was performed in 9 cases only. The median graft-to-body weight ratio was 0.55, requiring perioperative or intraoperative portal modulation in 16 cases. At least 1 complication occurred in 24 patients following the transplant procedure (morbidity rate, 89%). Four patients (4/27, 15%) died after the APOLT procedure. At the long term, 19 (70%) patients were alive and well at 13 months to 24 years (median, 4.5 years) including 18 with the APOLT graft in place and 1 following retransplantation.
UNASSIGNED: Despite high postoperative morbidity, and highly reported technical variability, the APOLT technique is a promising technique to use SFSGs in patients with CLD, achieving satisfactory long-term results. The results need to be confirmed on a larger scale, and a standardised technique could lead to even better results.
UNASSIGNED: At the cost of a high postoperative morbidity, the long-term results of APOLT for small-for-size grafts are good. Standardisation of the procedure and of portal modulation remain needed.