Chuanguan News reporter Li Huan
The reporter learned from West China Hospital of Sichuan University that a few days ago, under the guidance of Yan Lunan, a tenured professor of West China Hospital of Sichuan University, the team of Yang Jiayin/Professor Jiang Li from the Department of Liver Surgery of West China Hospital completed the “departure” Donor liver minus right posterior lobectomy (eRPS)” to prevent large liver syndrome after adult DCD (organ donation after cardiac death) liver transplantation. The study will be published in Transplant International, the official journal of the European Organ Transplantation Association in 2022. At the request of the editor-in-chief and reviewers, the new eRPS procedure is named “HuaXi (Huaxi)-eRPS” with the Huaxi label. formula. According to literature search, this new operation is the first liver transplantation-related operation named after HuaXi, and also the first liver transplantation-related operation named after a hospital or individual in mainland China. The original innovation of liver transplantation has been recognized and affirmed by authoritative experts in the field of liver transplantation at home and abroad, and has been concerned and affirmed by authoritative experts in the field of liver transplantation in Europe, America and Japan.
Large liver syndrome (LFSS) is a fatal complication that occurs when a large donor liver is implanted into a smaller body cavity of the recipient. In recent years, with the increasing incidence of obesity, the proportion of large-weight donors in the donor pool has increased year by year. However, the current organ allocation systems at home and abroad are mainly based on scores reflecting the severity of liver disease in recipients, and do not consider the mismatch of abdominal cavity morphological parameters between donors and recipients. As a result, almost all transplant centers face the problem of graft-to-recipient size mismatch in adult DCD liver transplantation, and the proportion of this problem is increasing.
At present, there are some problems in adult liver transplantation. For example, the preoperative prediction formulas for large liver syndrome are not uniform. Extrusion of the graft; at the same time, the cutting method of the adult donor liver is mainly based on “reducing the left lateral lobe or the left hemi-liver”, but it is likely that satisfactory results cannot be obtained, because the extrusion of the rib on the graft is mainly concentrated in the right liver However, cutting the left liver of the donor liver will not relieve the compression of the recipient’s right rib on the cut liver; therefore, some scholars have also proposed the surgical method of cutting the right half liver of the donor liver, but cutting the right half liver There may be insufficient left liver graft volume due to over-cutting, which increases the risk of postoperative small liver syndrome in recipients. It is too small to meet the metabolic needs of the recipient, and it is a fatal complication such as persistent cholestasis, hyperbilirubinemia, coagulation dysfunction, refractory ascites and hepatic encephalopathy that appear about 1 week after surgery. Therefore, directly cutting the right half of the liver, which accounts for about 65% of the whole liver volume, has a higher risk of SFSS (small liver syndrome) after the recipient, which is not convenient for promotion. In addition, there is no streamlined surgical prevention strategy for prediction-analysis-recommendation of donor liver trimming, and there are no indications corresponding to various trimming procedures.
At present, there is no precise formula for predicting LFSS (Large Liver Syndrome) in the world. Although it is convenient and quick to obtain, it does not take into account the influence of the right rib on graft extrusion, so its clinical practical predictive value remains questionable, and it does not have the advantage of individualized preoperative prediction.
The team from West China Hospital completed the world’s first in vitro right posterior lobe reduction surgery. This surgery has many advantages, especially the integrity of the right hepatic vein is preserved, so as to maximize the protection of the graft The integrity of the overall outflow tract; the right posterior lobe is the main component of the right liver, and the reduction of the right posterior lobe can effectively avoid the compression of the ribs and so on.