在高容量中心，复杂的供体解剖结构不影响机器人供肝切除术后早期供体或受体的结果。

IF 8.9 2区医学 Q1 SURGERY

American Journal of Transplantation Pub Date : 2025-04-28 DOI:10.1016/j.ajt.2025.04.017

Kamal S Yadav,Nikhitha Shetty,Fysal Valappil,Akash Selvathangam,Suchet Chaudhary,Ankur Gupta,Prashant Bhangui,Arvinder S Soin

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引用次数: 0

摘要

随着专业技术的发展，选择机器人活体肝切除术（RDH）供体的标准已经扩大。我们比较了标准移植和复杂移植在RDH中的供体和受体结果。方法：我们在4296例LDLT患者中进行了360例右叶RDH (RRDH)，其中280例随访超过6个月。前53例被排除，因为我们使用了不同的（切割缝合）技术来分割肝管。随后将227例RRDH分为标准移植组（S组，n=76）和复杂移植组（C组，n=151）。结果每组3例供体均转化为开放式中线切口。S组和C组分别有1例（1.3%）和3例（1.9%）出现胆道并发症（p=0.741）。两组患者术后早期和晚期并发症相似。C组患者晚期胆道并发症发生率无显著性增高[3例（3.9%）vs 17例（11.2%）；OR 3.09, 95% CI 0.88-10.88, p=0.067]。早期（< 30天）受体死亡率相似，S组4例（6.6%），C组11例（7.3%）（p=0.755），均与脓毒症有关。结论标准移植和复杂移植的供体和受者预后相似。有了经验，RDH可以安全地提供给“所有角落”的献血者，并有可能成为标准的护理。

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COMPLEX DONOR ANATOMY DOES NOT INFLUENCE EARLY DONOR OR RECIPIENT OUTCOMES AFTER ROBOTIC DONOR HEPATECTOMY AT A HIGH VOLUME CENTER.

INTRODUCTION With evolving expertise, criteria to select donors for robotic living donor hepatectomy (RDH) have expanded. We studied the comparative donor and recipient outcomes in RDH with standard grafts and complex grafts. METHODS We have performed 360 right lobe RDH (RRDH) out of 4296 LDLT, with 280 having over 6 months follow-up. First 53 cases were excluded as we used a different (cut-suture) technique for hepatic duct division. Subsequent 227 RRDH were then divided into donors with standard (group S, n=76) and complex grafts (group C, n=151). RESULTS Three donors in each group were converted to open midline incision. In Groups S and C, 1(1.3%) and 3(1.9%) donors developed biliary complications (p=0.741). Both recipient groups had similar early and late post-operative complications. Group C recipients had non-significantly higher incidence of late biliary complications [3(3.9%) vs 17(11.2%); OR 3.09, 95% CI 0.88-10.88, p=0.067]. Early (< 30days) recipient mortality was similar with 4(6.6%) in group S, and 11(7.3%) in group C (p=0.755), all sepsis related. CONCLUSION The outcomes were similar among donors and recipients with both standard and complex grafts. With experience, RDH can be safely offered to "all comer" donors and has the potential to become standard of care.

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来源期刊

American Journal of Transplantation 医学-外科

CiteScore

18.70

自引率

4.50%

发文量

346

审稿时长

26 days

期刊介绍： The American Journal of Transplantation is a leading journal in the field of transplantation. It serves as a forum for debate and reassessment, an agent of change, and a major platform for promoting understanding, improving results, and advancing science. Published monthly, it provides an essential resource for researchers and clinicians worldwide. The journal publishes original articles, case reports, invited reviews, letters to the editor, critical reviews, news features, consensus documents, and guidelines over 12 issues a year. It covers all major subject areas in transplantation, including thoracic (heart, lung), abdominal (kidney, liver, pancreas, islets), tissue and stem cell transplantation, organ and tissue donation and preservation, tissue injury, repair, inflammation, and aging, histocompatibility, drugs and pharmacology, graft survival, and prevention of graft dysfunction and failure. It also explores ethical and social issues in the field.