Cacciarelli T V, Dvorchik I, Mazariegos G V, Gerber D, Jain A B, Fung J J, Reyes J
Department of Transplant Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Transplantation. 1999 Sep 15;68(5):650-5. doi: 10.1097/00007890-199909150-00010.
The present study analyzes pretransplantation variables associated with long-term liver allograft survival in 278 children who underwent transplantation under primary tacrolimus (FK506) therapy at a single center between October 1989 and October 1996.
The influence of 17 pretransplantation variables on long-term liver allograft outcome was analyzed. Donor variables included age, weight, gender, and cold ischemia time. Recipient variables included age, weight, gender, original liver disease, pretransplantation waiting time, previous abdominal surgery, United Network of Organ Sharing (UNOS) status, ABO blood group, bilirubin level, prothrombin time, ammonia level, creatinine level, and reduced-size/split liver grafts.
Overall actuarial graft survival was 79.9% at 1 year, 79.1% at 2 years, and 78.3% at 3, 4, and 5 years. Retransplantation rate was 10.8%. Pretransplantation variables with a significant adverse effect on graft survival by univariate analysis were donor age < or = 1 year (P<0.004), donor weight < or = 10 kg (P<0.003), UNOS status I and II (P<0.007), ABO type O, B, and AB (P<0.03), and reduced-size/split liver grafts (P<0.02). Pretransplantation variables significant by multivariate analysis and therefore independent predictors of inferior graft outcome were donor weight '10 kg (relative risk [RR] 2.91, confidence interval [CI] 1.53-5.51); reduced-size/split liver grafts (RR 2.53, CI 1.30-5.64); and UNOS status I (RR 2.22, CI 1.11-4.43).
Pediatric liver transplant recipients receiving primary tacrolimus therapy have long-term graft survival rates approaching 80%. UNOS status, donor weight, and the use of reduced-size/split liver grafts are the most important factors affecting survival.
本研究分析了1989年10月至1996年10月间在单一中心接受初次他克莫司（FK506）治疗的278例儿童肝移植受者中与肝移植长期存活相关的移植前变量。
分析了17个移植前变量对肝移植长期结局的影响。供体变量包括年龄、体重、性别和冷缺血时间。受体变量包括年龄、体重、性别、原发病、移植前等待时间、既往腹部手术史、器官共享联合网络（UNOS）状态、ABO血型、胆红素水平、凝血酶原时间、氨水平、肌酐水平以及减体积/劈离式肝移植。
1年时总体精算移植存活率为79.9%，2年时为79.1%，3、4和5年时为78.3%。再次移植率为10.8%。单因素分析显示对移植存活有显著不利影响的移植前变量为供体年龄≤1岁（P<0.004）、供体体重≤10 kg（P<0.003）、UNOS状态I和II（P<0.007）、ABO血型O、B和AB型（P<0.03）以及减体积/劈离式肝移植（P<0.02）。多因素分析显示有显著意义且因此为移植结局较差的独立预测因素的移植前变量为供体体重≤10 kg（相对危险度[RR] 2.91，可信区间[CI] 1.53 - 5.51）；减体积/劈离式肝移植（RR 2.53，CI 1.30 - 5.64）；以及UNOS状态I（RR 2.22，CI 1.11 - 4.43）。
接受初次他克莫司治疗的小儿肝移植受者长期移植存活率接近80%。UNOS状态、供体体重以及减体积/劈离式肝移植的使用是影响存活的最重要因素。
