Millis J M, Cronin D C, Brady L M, Newell K A, Woodle E S, Bruce D S, Thistlethwaite J R, Broelsch C E
Sections of Transplantation Surgery, University of Chicago, Chicago, Illinois 60637, USA.
Ann Surg. 2000 Jul;232(1):104-11. doi: 10.1097/00000658-200007000-00015.
To evaluate the impact of technical modifications on living-donor liver transplants in children since their introduction in 1989.
Although more than 4,000 liver transplants are performed every year in the United States, only approximately 500 are performed in children. Living-donor liver transplantation has helped to alleviate the organ shortage for small children in need of liver transplantation. Few centers have amassed a sufficient number of cases to evaluate the impact of the different techniques used in pediatric living-donor liver transplantation.
From 1989 through 1997, 104 primary living-donor liver transplants were performed at the University of Chicago. Three phases of the living-donor liver transplant program can be defined based on the techniques of vascular reconstruction: phase 1, November 1989 to November 1994 (n = 78); phase 2, November 1994 to January 1996 (n = 6); and January 1996 to present (n = 20). The patients' charts were reviewed retrospectively. The incidence and type of vascular complications and patient and graft survival rates were analyzed.
Although the demographics of the patients have not changed during the three phases of the living-donor liver transplant program, the outcomes have improved. Without the use of conduits, the incidence of portal vein complications has significantly decreased from 44% to 8%. The incidence of hepatic artery thrombosis has decreased from 22% to 0% with the use of microvascular techniques. The combined use of both techniques has led to a significant increase in graft survival, from 74% to 94%.
The living-donor liver transplant recipient operation has undergone significant technical changes since its introduction in 1989. These changes have decreased the vascular complications associated with this type of graft. Avoiding the use of vascular conduits and performing microvascular hepatic artery anastomoses are the critical steps in improving graft survival.
评估自1989年技术改进引入以来对儿童活体肝移植的影响。
尽管美国每年进行超过4000例肝移植手术，但儿童肝移植手术每年仅约500例。活体肝移植有助于缓解急需肝移植的小儿器官短缺问题。很少有中心积累了足够数量的病例来评估小儿活体肝移植中所使用的不同技术的影响。
1989年至1997年期间，芝加哥大学共进行了104例初次活体肝移植手术。根据血管重建技术可将活体肝移植项目分为三个阶段：第1阶段，1989年11月至1994年11月（n = 78）；第2阶段，1994年11月至1996年1月（n = 6）；第3阶段，1996年1月至今（n = 20）。对患者病历进行回顾性分析。分析血管并发症的发生率和类型以及患者和移植物的存活率。
尽管在活体肝移植项目的三个阶段患者的人口统计学特征没有变化，但结果有所改善。不使用血管导管时，门静脉并发症的发生率从44%显著降至8%。采用微血管技术后，肝动脉血栓形成的发生率从22%降至0%。两种技术的联合使用使移植物存活率显著提高，从74%提高到94%。
自1989年引入以来，活体肝移植受者手术经历了重大技术变革。这些变革减少了与这种类型移植物相关的血管并发症。避免使用血管导管和进行微血管肝动脉吻合是提高移植物存活率的关键步骤。
