活体肝切除术中右肝移植物的原位血流动力学和氧利用。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-04-28 DOI:10.1016/j.transproceed.2025.03.018

Yong K. Kwon , Navpreet Kaur , Yuri Genyk

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引用次数: 0

摘要

背景：几项研究已经检查了活体肝移植过程中的肝移植物血流动力学；然而，据我们所知，供体肝切除术期间部分移植物的血流动力学尚未得到彻底的探讨。我们分析了活体供肝切除术中肝实质清扫后的移植物术中血流动力学和氧利用数据。方法：对63例右肝叶活体供肝切除术患者术中测量右门静脉（RPV）和右肝动脉（RHA）实质横断后的血流量，并对右门静脉（RPV）、右肝动脉（RHA）和右肝静脉进行血气分析。利用这些血流和血气分析数据，计算和分析右叶移植物的氧输送和耗氧量。结果：随着门静脉梯度的增加，移植物重量归一化RHA流量明显减少，而移植物重量归一化RPV流量保持相对恒定。在男性和女性献血者之间没有观察到体重标准化流量或血气数据的差异。然而，与年轻供者相比，年龄在40岁及以上的供者在移植重量标准化RHA氧输送方面表现出统计学上显著的减少（P = 0.042）。结论：高门静脉压力和供者年龄是已知的活体肝移植小体积综合征的危险因素。我们的数据显示，即使门静脉梯度相对较小的增加也会显著降低RHA流量，对氧气输送产生负面影响。这表明右叶移植物可能容易发生缺血性损伤，特别是来自老年供体的移植物与受体体重比较低的受体。

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In-Situ Hemodynamics and Oxygen Utilization in Right Lobe Grafts During Living Donor Hepatectomy

Background

Several studies have examined liver graft hemodynamics during living donor liver transplants; however, to the best of our knowledge, the hemodynamics of the partial graft during donor hepatectomy have not been thoroughly explored. We analyzed intraoperative graft hemodynamics and oxygen utilization data following parenchymal dissection during living donor hepatectomy.

Methods

The following parameters were measured intraoperatively in 63 right hepatic lobe living donor hepatectomy cases: right portal vein (RPV) and right hepatic artery (RHA) blood flow after parenchymal transection, along with blood gas analysis from the RPV, RHA, and right hepatic vein. Using these flow and blood gas analysis data, oxygen delivery and oxygen consumption of the right lobe graft were calculated and analyzed.

Results

A significant decrease in graft weight-normalized RHA flow was observed as the portal vein gradient increased, while graft weight-normalized RPV flow remained relatively constant. No differences in weight-normalized flow or blood gas data were observed between male and female donors. However, donors aged 40 years and older exhibited a statistically significant reduction in graft weight-normalized RHA oxygen delivery compared to younger donors (P = .042).

Conclusions

High portal pressure and donor age are known risk factors for small-for-size syndrome in living donor liver transplantation. Our data showed that even a relatively small increase in portal vein gradient significantly reduces RHA flow, negatively affecting oxygen delivery. This suggests that right lobe grafts may be prone to ischemic injury, especially in recipients with a low graft-to-recipient weight ratio from older donors.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.