Application Effectiveness Of Segment Ⅳ Portal Vein Reconstruction For Early Postoperative Liver Function Recovery In Split Liver Transplantation

Objective:Since the first liver transplantation in the world,liver transplantation has become the most effective means to treat all kinds of liver disease and hundreds of thousands of patients with end-stage liver disease around the world.The source of donor liver has always been a very big problem,so expanding the source of donor liver has always been a problem.After the first successful reduction of liver transplantation,one liver can be transplanted into two recipients,thus expanding the source of liver donors.Statistics show that SLT surgery can improve donor availability by 20%,which solves the problem of donor availability for experts in this field.The ideal splitting donor is obviously young people,has non liver disease history and normal liver enzymes,stable hemodynamic and hospital stay was short in other words age,ABO compatibility,size matching,liver function,vasopressor demand,lack/insufficiency of arrest time,shortened donor hospital stay and serum sodium concentration have been used in various studies to narrow the scope of donor selection and achieve the best prospect.In recent years,some people have proposed different criteria for donor segmentation,and the standards of countries and transplant institutions are different.NITp established a specific multicenter SLT program in 1997.In a recently released report,the following donor eligibility criteria for segmentation surgery are listed:age less than 60 years,length of stay in intensive care unit less than 5 days,low muscle strength support（dopamine 5 g/kg/min,dobutamine 10 g/kg/min,no adrenaline or noradrenaline）,The liver function test was close to normal.UNOS method,MELD scoring model and waiting list criteria are adopted by the transplantation community almost all over the world because it can provide a better matching ratio between donors and recipients.The size matching of graft to receptor weight ratio（grwr）is very important;Although a grwr of 0.6%for LDLT may be acceptable,a grwr of at least0.8%is recommended for deceased donor isolated liver transplantation in adult recipients.Statistics of patients receiving split liver transplantation was analyzed in the Department of liver transplantation of the Affiliated Hospital of Qingdao University from January 2015 to January 2022.Firstly,the general clinical data of split liver transplantation in our center and the recovery of transplanted liver function after follow-up were statistically analyzed（divided into more than 3 years,1～3 years and 1 year）.From January 2015 to January 2022,a total of 62 patients received split liver transplantation in the liver transplantation Department of the Affiliated Hospital of Qingdao University,including 27 males and 35 females;43 adults and 19 children;8 cases were transplanted in vivo（including 4 cases of left lateral lobe,3 cases of left half liver and 1 case of right half liver）,and 54 cases of DBD division in vivo;The donors were left lateral lobe in12 cases,left half liver in 12 cases,right half liver in 14 cases and right third lobe in 24 cases;The causes of adult include 14 cases of liver malignant tumors,13 cases of decompensated cirrhosis after hepatitis B,4 cases of cirrhosis after autoimmune hepatitis,3 cases of drug-induced liver damage and 9 cases of liver failure from other causes.There were 7 cases of biliary atresia,8 cases of congenital metabolic diseases（including 2 cases of hepatolenticular degeneration）and 4 cases of liver failure due to other causes.It also includes difficult operations,such as domino liver transplantation and secondary liver transplantation.In our study,various data statistics were evaluated.SLT is our preferred transplantation technique for infants and young children.Due to its advantages and lack of donor risk,it is impossible to obtain the whole organs of cadavers.The development of SLT benefits from the great efforts of a few centers around the world to overcome major obstacles.In the process of donor liver repair,blood vessels should be reconstructed to restore the integrity of the transplanted liver pipeline as much as possible.For the right trefoil donor liver,the donor iliac artery was used to reconstruct the portal vein of segment Ⅳ of the liver,so as to avoid bile leakage and infection caused by ischemia and necrosis of segment Ⅳ liver tissue after operation.When the branch of hepatic Ⅳ portal vein is disconnected,enough length should be reserved to supply the liver to the right third lobe as much as possible,so as to reconstruct the Ⅳ portal vein at this stage.One month after operation,portal vein stent was implanted,portal vein blood flow recovered,donor liver function gradually recovered,and the patient was discharged smoothly.To investigate the significance of donor Ⅳ portal vein reconstruction in the early recovery of liver function after split liver transplantation.The clinical data of 32 right trefoil split liver transplant recipients in the organ transplantation center of the Affiliated Hospital of Qingdao University from January,2015 to January,2022 were retrospectively analyzed.They were divided into two groups for calculation and analysis.The data were processed and measured by Stata statistical software.The control group（non-reconstructed PTV）,Construction group（reconstruction PTV group）and postoperative LFT were analyzed,including ALT,AST,ALB,Cr,TB,ALP,GGT and Lac.The data were expressed as mean±standard deviation.For independent samples,t-test was used to compare the reconstruction group and the control group.Results:After running the T-test in stata for data comparing of ALT,AST,ALB,Cr,TB,ALP,GGT and Lac.The comparison levels showed that there was significant difference in levels of ALT on 2^nd,4^th,5^th,6^th and 7^th and Lac at 1^st day after operation between control and re-construction group.There was no significant difference in levels of AST,ALB,Cr,TB,ALP and GGT in any of data we collected（P<0.05）.The reconstruction of donor hepatic vein segment had a significant effect on liver function within 1 week after operation.The application of donor liver Ⅳ portal vein reconstruction technology is conducive to the early recovery of liver function.Within 1 week after liver transplantation,segment Ⅳ portal vein reconstruction has a significant effect on the recovery of liver function.