Abstract:

Objective Split liver transplantation （SLT） is an important innovative technique in transplant surgery that addresses the shortage of donor livers and expands the source of donor organs. Currently， the number of hepatocellular carcinoma patients undergoing SLT is increasing year by year， but its impact on the occurrence of complications and prognosis in hepatocellular carcinoma recipients compared with whole liver transplantation （WLT） remains unclear. This study aims to explore the differences in the occurrence of complications and prognosisbetween WLT and SLT recipients with hepatocellular carcinoma， and to construct a prognostic prediction model forhepatocellular carcinoma recipients underwent SLT by analyzing the prognostic factors. Methods A retrospective selection of 3 773 adult recipients with hepatocellular carcinoma who underwent WLT and SLT registered in the ChinaLiver Transplant Registry （CLTR） from January 2015 to December 2023 was conducted. Clinical data of donors and recipients were collected to compare the clinicopathological characteristics of donors and recipients， the occurrence ofcomplications and prognosis of recipients between the two surgical methods was evaluated. Propensity score matching （PSM） at a 2 ：1 ratio was used to match the baseline clinical data with differences between the WLT and SLT groups，and the incidence of complications and prognosis in the two groups were analyzed. Univariate and multivariate analyses were performed to screen for risk factors related to the prognosis of SLT recipients， and then a prognostic prediction model

was constructed. Results There was no significant difference in the overall survival rate and recurrence-free survival rate between SLT recipients and WLT recipients （P ＞ 0.05）. However， the incidence of postoperative biliary leakage，portal vein embolism， and new-onset diabetes after surgery in SLT recipients were significantly higher than those in theWLT group （postoperative biliary leakage，P ＝ 0.0010 ； portal vein embolism，P ＝ 0.0044 ； new-onset diabetes after surgery，P ＝ 0.036）. Univariate and multivariate analyses of the prognosis of SLT recipients found that donor-recipient

ABO blood type incompatibility， recipient alpha-fetoprotein （AFP）＞ 100 ng/ml， and cumulative tumor diameter ≥ 8 cm were independent risk factors for the prognosis of SLT hepatocellular carcinoma recipients （all P ＜ 0.05）. A prognostic prediction model for SLT recipients was constructed based on the above risk factors， with AUC values of 0.561，0.698， and 0.687 for 1-year，3-year， and 5-year survival rates， respectively. Conclusion The incidence of some postoperative complications in SLT recipients is higher than that in WLT recipients， but the clinical prognosis is similar. Among them，donor-recipient ABO blood type incompatibility， recipient AFP ＞ 100 ng/ml， and cumulative tumor diameter ≥ 8 cm areindependent risk factors affecting the prognosis of SLT hepatocellular carcinoma recipients. The prediction model establishedon this basis has good predictive value for the survival rate of recipients. 

Key words:

Split liver transplantation ,  , Hepatocellular carcinoma ,  , Propensity score matching ,  , Prognostic wprediction model ,

摘要：

目的 劈离式肝移植（split liver transplantation， SLT）是应对供肝来源短缺、拓展供肝来源的重 要移植外科技术创新。目前，肝癌患者行 SLT 数量呈逐年上升，但其与全肝肝移植（whole liver transplantation，WLT）相比对肝癌受者并发症发生及预后的影响及尚不明确。本研究旨在探索 WLT 与 SLT 肝癌受者并发症发生与预后的差异，并进一步分析 SLT 肝癌受者的预后影响因素进而构建预后预测模型。方法 回顾性选取于 2015 年 1 月至 2023 年 12 月在中国肝移植注册中心（China Liver Transplant Registry， CLTR）登记的 3 773 例 因肝癌行 WLT 和 SLT 的成年受者。收集供者和受者临床特征资料，对比两种手术方式的供受者临床病理特征及受者并发症发生、预后。采用 2 ：1 的倾向性评分匹配（propensity score matching， PSM）匹配 WLT 和 SLT 存 在差异的临床基线数据，分析 WLT 和 SLT 组的受者并发症发生率及预后情况。采用单因素及多因素分析筛选 SLT 受者预后相关危险因素，进而构建预后预测模型。结果 SLT 受者总体生存率和无复发生存率与 WLT 受者无显著差异（P ＞ 0.05），但 SLT 受者术后胆漏、门静脉栓塞和术后新发糖尿病的发生率均显著高于 WLT 组 （术后胆漏，P ＝ 0.0010 ；门静脉栓塞，P ＝ 0.0044 ；术后新发糖尿病，P ＝ 0.036）。SLT 受者预后的单因素及 多因素分析发现供受者 ABO 血型不相符、受者甲胎蛋白（alpha-fetoprotein，AFP）＞ 100 ng/ml 和累计肿瘤直径≥8 cm是SLT肝癌受者预后的独立危险因素（均P＜0.05）。于上述危险因素构建了SLT受者的预后预测模型，其 1、3、5 年生存率 AUC 分别为 0.561、0.698、0.687。结论 SLT 受者的部分术后并发症发生率较 WLT 受者升高，但临床预后相仿。其中，供受者 ABO 血型不相符、受者 AFP ＞ 100 ng/ml 和累计肿瘤直径≥ 8 cm 是影响 SLT 肝癌受者预后的独立危险因素，以此为基础建立预测模型对受者的生存率具有较好的预测价值。

关键词:  , 劈离式肝移植 , 肝细胞癌 , 倾向性评分匹配 , 预后预测模型