The prognostic value of the site and extent of Y chromosome microdeletions on spermatogenesis

Genes on Y-chromosome are involved in the regulation of spermatogenesis. Y-chromosome microdeletions were identified among infertile patients in a frequency of 7.5-15% on the long arm of the chromosome. These microdeletions were clustered in 3 main regions named AZFa, AZFb, and AZFc. Reanalyzing the histological findings in men with well-defined varying extent of Y-chromosome microdeletions improved our understanding of the prospect of finding testicular spermatozoa. The chances of finding spermatozoa were almost nil in men with microdeletions that include the complete AZFa region or AZFb region or at least two AZF regions. Large microdeletions that include the Yq tip were suggested to cause chromosomal instability and were shown to be prone to Y chromosome loss. In addition, a decrease of sperm count over time in men with AZFc deletions has been reported and the option of spermatozoa cryo-preservation need to be taken in consideration. Analysis of the Y-chromosome microdeletion was found to be of prognostic value in cases of infertility both in terms of clinical manage-cations or heterologous transfusion. Three recipients (15%) died. Graft survival is 70% (mean follow-up, 8 months). Mean graft: recipient weight ratios (GRWR) were 0.75%±0.21% (range, 0.51-1.06) in LL recipients, and 1.10%±0.15% (range, 0.93-1.44) in RL recipients. Four recipients of relatively small LL grafts (GRWR < 0.8%), all with Child's B or C cirrhosis, developed small-for-size syndrome. One died; 2 required retransplantation. Small LL grafts were used successfully in Child's A patients or noncirrhotics (the indication for transplantation was tumor). The LL group had 5 bile leaks (50%) and 3 major vascular complications (30%). One was fatal; 1 mandated retransplantation. The RL group had 2 biliary leaks (20%) and 1 hepatic artery thrombosis, which necessitated retransplantation. Conclusions: Right lobe grafts prevented small-for-size syndrome. Although donor hepatectomy and recipient grafting are technically more demanding, right lobe grafting seems to involve fewer recipient complications and better outcome.