Asonuma K, Inomata Y, Uemoto S, Egawa H, Kiuchi T, Okajima H, Shapiro A M, Tanaka K
Department of Transplantation and Immunology, Kyoto University, Japan.
Pediatr Transplant. 1998 Feb;2(1):64-9.
Fifty-six consecutive pediatric recipients surviving more than 3 yr after living-related liver transplantation (LRLT) were evaluated in terms of growth, quality of life (QOL) and need for maintenance immunosuppression. Significant improvement in Z-score for height and weight were observed at last follow-up, ranging from 3 to 6 yr after transplantation, although catchup height gain lagged behind recovery in weight (height: -1.77 pre-transplant to -0.77 post-transplant, p<0.001; weight: -1.12 pre-transplant to -0.18 post-transplant, p<0.0001). 82% (46) recipients have remained in good health and have an excellent QOL as assessed in the most recent 6 months; these children lead similar daily lives to normal healthy children, with daily school attendance and full participation in activities including gymnastics and hiking. 3.6% (2) recipients attended school regularly but were unable to participate in sporting activities. 14% (8) recipients remain home or hospital-bound due to persistent complications in the past 6 months, with only minimal school attendance. Less than 10% of recipients were taking steroids by 2 yr post-transplantation, although approximately half of the children were receiving low-dose maintenance steroids at 1 yr. The mainstay immunosuppressant was tacrolimus, with 68% (38) recipients receiving daily therapy, 8.9% (5) alternate-day, 8.9% (5) twice a week, and 5.4% (3) a single dose weekly or alternate weeks. 7.1% (4) recipients were withdrawn completely from all immunosuppressants, including tacrolimus, for various reasons. 8.9% (5) patients have needed multiple immunosuppressive agents over the last 6 months. In conclusion, LRLT restores growth and offers excellent quality of life in pediatric recipients. The majority of recipients require minimal, steroid-free, immunosuppression by 2 yr post-transplant, but the occasional recipient still needs intensive longterm immunosuppression.
对56例活体亲属肝移植（LRLT）后存活超过3年的连续儿科受者进行了生长、生活质量（QOL）及维持免疫抑制需求方面的评估。在移植后3至6年的最后一次随访中，观察到身高和体重的Z评分有显著改善，尽管追赶性身高增长落后于体重恢复（身高：移植前-1.77至移植后-0.77，p<0.001；体重：移植前-1.12至移植后-0.18，p<0.0001）。82%（46例）受者保持健康，在最近6个月评估中生活质量极佳；这些儿童的日常生活与正常健康儿童相似，每天上学并充分参与包括体操和徒步旅行在内的活动。3.6%（2例）受者定期上学，但无法参加体育活动。14%（8例）受者在过去6个月因持续并发症而居家或住院，仅极少上学。移植后2年时，不到10%的受者服用类固醇，尽管约一半儿童在1年时接受低剂量维持类固醇治疗。主要免疫抑制剂为他克莫司，68%（38例）受者每日治疗，8.9%（5例）隔日治疗，8.9%（5例）每周两次，5.4%（3例）每周或隔周单剂量治疗。7.1%（4例）受者因各种原因完全停用包括他克莫司在内的所有免疫抑制剂。8.9%（5例）患者在过去6个月需要多种免疫抑制剂。总之，活体亲属肝移植可恢复儿科受者的生长并提供极佳的生活质量。大多数受者在移植后2年需要极少的、无类固醇的免疫抑制，但偶尔有受者仍需要长期强化免疫抑制。
