HOI GAN MA ‘NAM (VASLD) Phan h@i Phau thuat Gan Mat Tuy Viét Nam (VSHBPS) TAP CHI GAN MAT VIET NAM Vietnamese Journal of Hepatology S639 - 2019 Phat hanh toan quéc30 Tap chi GAN MAT VIET NAM sé 39-2019 Két qua buéc dau ghép gan tir ngwai cho séng ding manh ghép gan phai tai bénh vién Vinmec Initial Outcome of Living Donor Liver Transplantation Using Right Lobe Graft in Vinmec Hospital Hoang Ditc Nam*, Dao Dire Diing”*, Park Young Mok*, Chu Chong Woo* Tom tat: Tong quan: 24 bénh nhan duoc ghép gan tie ngudi cho song tai BVPKOT Vinmec tir thang 4.2017 - 1.2019. Nguwdi hién (tudi tie 21- 49), nhoém mau tuong dong (1 ca khac biét nhom Rh). Nguoi nhGn tudi tir 9 - 66, ti lé nam/nit la 19/5. Chi dinh ghép gan o ‘bénh ly xo gan mat ba, ung thu gan, suy gan cap va mot sé bénh ly khac. Phau thudt dugc thc hién cap ctru hodc chuong trinh. Manh ghép gan phai dugc ap dung trong tat ca trudng hop. Két qua: Doi voi nguoi hién: khéng co tie vong, khéng can truyén mau trong va sau mé. Mét ca hién bi bién ching hep duong mat sau mé dugc mé Iqi thanh cong. Thoi gian nam vién trung binh ngudi hién la 9 + 3 ngay. Ti lé phan gan trai dé Summary: Background: 24 LDLT performed in Vinmec In- ternational Hospital — Hanoi, Vietnam since Apr 2017 to Jan 2019. Donor age from 21-49, with in- dentical ABO blood group. Recipients of the age of 9-66, male/female ratio was 19:5. LDLT indica- tions mainly for cirrhosis due to HBV, hepatocel- lular carcinoma, acute liver failure and other end stage liver diseases. These have been performed in both urgent and routine circumstancy. Results: No mortality, and no transfusion needed perioperatively in the donors. One complication happened in donors that underwent reoperation due to biliary stricture, which recovery well. Aver- age length of hospital stay was 9 + 3 days. Donor post-operative remnant liver volume was 42.9 lai sau mé la 43 + 4%. Gan trdi tang sinh, dat ti trong 77,8 + 11,1% so voi gan nguyén thuy, sau trung binh 3,5 + 2,6 thang. Doi voi nguoi nhan: chi sé MELD Score trung binh 17 + 11. Thoi gian nam vién trung binh 29 + 18 ngay (15-103). Ti lé song thém 1 nam Ia 78,9%, tir vong trong 30 ngay sau mé 1 ca. Théi gian song thém trung binh dat 11,9 + 7,0 thang. Bién chitng ngoai khoa 6/24 truong hop (4 ca phai mé lai). Két lu@n: Ghép gan tr nguoi cho song voi manh ghép gan phdi cé thé thuc hién voi su chon lua chi dinh thich hop va sang loc chuan bj ti mi nguoi hién. Két qua bude dau rat kha quan, giup giai quyét tic thoi nhu cau ghép tang cap cttu, rit ngan thoi gian cho dgi tang hién cting nhu su khan hiém nguén tang tai Viét Nam. 4.1%. The left liver later hyper-trophy up to 78 + 11% compared with the original liver, in 3.5 + 2.6 months. Average MELD Score in recepients was 17+ 11. Average length of hospital stay in recipient was 28.5 + 17.8 days (15-103). 1-year survival was 78.9%, post-operative 30-day mortality in one case. Survival period achieved 11.9 + 7.0 months. Surgical-related complications in recipients at 6/24 cases, reoperation needed in 4 cases. Conclusions: LDLT with was feasible and can be safely performed with justified indications as well as extremely well preparation and care for the donors. Initial outcome was really encouraging, which help overcome the scarce of donor organ as well as shorten the waiting time. a en * BVDKQT Vinmec. Phan bién khoa hoc: GS TS Lé Trung Hai va PGS TS Lé Thanh SonI. Dat van dé Chi dinh ghép gan ngay cang duge mé rong, nhu cau gan ghép ngay cang gia tang trén thé gidi néi chung. Chau A 14 khu vuc c6 hoat déng hién tang chét nao thap hat trén thé gidi véi ti 1é tir 0,05- -4,04/1 trigu dan nam 2000, ting 1én 0,05- 6,0/1 trigu din nam 2010; so véi tilé nay é My 1a 22,3 va 17,0/1 triéu din nam 2000 va nam 2010.[5] Ghép gan ti ngudi cho séng (Living donor liver transplantation - LDLT) gitp gidi quyét tire thdi van dé khan hiém tang ghép, da dugc thyc hién thanh céng lan dau tién trén thé gidi nam 1989 véi manh ghép gan trai tit me cho con [16][19]. Bénh vign Queen Mary — Héng Cong (thang 5.1996) thuc hién thanh cong ghép gan ngudi én LDLT véi manh ghép gan phai lan dau tién trén thé gidi.[13] Tiép theo, Asan Medical Center (Han Quéc, nam 1997), Bénh vién Dai hoc Kyoto Nhat Ban va nhom Essen Chau Au nam 1998 bao cao thuc hién thanh céng ky thuat nay [11]. Ké tir do, loai hinh phau thuat nay ngay cang dugc img dung rng rai trén thé gidi, dic biét cdc nuéc ving Chau A, nhu Nhat Ban, Han Quéc, Hong Céng, Dai Loan ... Cac két qua ghi nhan duoc gan day cho thay két qua sau ghép la tuong duong, hoc tham chi t6t hon cdc trudng hop ghép chét nao [1][9]. Tai Viét Nam, ghép gan dong vi tri da duge trién khai tir nim 2004, la mét ca ghép gan tré em tirngudi cho séng [17]. Dén thang 3/2019 ca nuée ghép khoang gan 150 ca, nguén hién chu yéu tir ngudi cho chét nao (DDLT) trong hon 2/3 trudng hop. Ching t6i tong két 24 trang hop ghép gan tir ngudi cho song da thy hién tai 1 Trung tam ¢ Viét Nam (Vinmec Times City). Il. Déi tong va phuong phap nghién cru 2.1. Déi twgng nghién ciru: gom 24 bénh nhan duge ghép gan tai BVDKQT Vinmec tt thang 4.2017 dén thang 1.2019. Ngudi hién (tudi tir 21-49), nhom mau tuong déng (1 ca khac biét nhém Rh). Nguoi nhan tudi tir 9-66, 19 nam va 5 nit. Tap chi GAN MAT VIET NAM sé 39-2019 31 Chon lua bénh nhan: Chi dinh ghép gan 6 bénh ly xo gan mat bu (v6i MELD score >15), ung thu gan, suy gan cap va m6t s6 bénh ly khac. Ung thu gan duge chi dinh ghép trong tiéu chi Milan, khéng cé di cin ngoai gan. Cac truéng hop suy gan cdp-téi cdp dugc danh gia toan thin, chup CT so nao danh gid mirc d6 ph nao, MELD Score < 40. Chon lwa nguoi hién: CAc trong hop hién tang dugc kiém tra phap ly nghiém ngat, tuan thu quy trinh ghép tang cia Bo Y té Viét Nam, déng thoi théng bao cho Trung tam diéu phdi ghép tang quéc gia. Sau khi x4c nhan phap ly, qua trinh sang loc ngudi hién gdm 3 giai doan. Giai doan 1 kiém tra phi hop nhém mau ABO-Rh; HbsAg, AntiHCV va HIV Ab 4m tinh. Giai doan 2 chup CT scan gan 3 thi (do thé tich cdc ving gan phai-trai, dung hinh hé thong mach mau gm d6éng mach gan, tinh mach cira va cdc tinh mach gan. Phan loai bién thé d6ng mach gan theo Michels, tinh mach cira...); Chup MRI chudi xung duéng mat dung hinh cay duéng mat. Bién thé dudng mat trong gan, dac biét vi tri hop luu cdc 6ng mat gan phai theo Hwang va cs [9][18] dong thoi dinh gid d6 nhiém mé gan. Giai doan 3 lam xét nghiém téng thé theo protocol thong nhat. Newoi hién dat yéu cau khi ti 1é trong ” lugng manh ghép gan phai/trong luong ngudi nhan (GRWR) 2 = 0.8%; gan trai con lai > 40%, khong c6 bat thudng phite tap giai phdu mach mat ving rén gan, d6 nhiém mo gan duoc chap nhan dudi 20%. Thé tich gan chudn (SLV: Standard Liver Vol- ume) duge tinh theo céng thitc SLV = 706,2 x BSA + 2.4 (mL) (BSA — Body Surface Area: dién tich da toan b6)[4][20]. 2.2. Phuong phap nghién ciru Phuong phdp phau thudt 6 nguoi hien: Manh ghép gan phai (right lobe) kém m6t phan xa tinh mach gan gitta dugc 4p dung trong tat ca truéng hop. Mo bung duodng chit J dudi sudén phai. Siéu 4m trong m6 dinh vi truc tinh mach gan gitta va cat nhu mé gan bang CUSA theo truc tinh