Emre S, Soejima Y, Altaca G, Facciuto M, Fishbein T M, Sheiner P A, Schwartz M E, Miller C M
Recanati/Miller Transplantation Institute, Mount Sinai Hospital of Mount Sinai/NYU Health, New York, NY, USA.
Liver Transpl. 2001 Jan;7(1):41-7. doi: 10.1053/jlts.2001.20940.
Pediatric donor (PD) livers have been allocated to adult transplant recipients in certain situations despite size discrepancies. We compared data on adults (age > or = 19 years) who underwent primary liver transplantation using livers from either PDs (age < 13 years; n = 70) or adult donors (ADs; age > or = 19 years; n = 1,051). We also investigated the risk factors and effect of prolonged cholestasis on survival in the PD group. In an attempt to determine the minimal graft volume requirement, we divided the PD group into 2 subgroups based on the ratio of donor liver weight (DLW) to estimated recipient liver weight (ERLW) at 2 different cutoff values: less than 0.4 (n = 5) versus 0.4 or greater (n = 56) and less than 0.5 (n = 21) versus 0.5 or greater (n = 40). The incidence of hepatic artery thrombosis (HAT) was significantly greater in the PD group (12.9%) compared with the AD group (3.8%; P =.0003). Multivariate analysis showed that preoperative prothrombin time of 16 seconds or greater (relative risk, 3.206; P =.0115) and absence of FK506 use as a primary immunosuppressant (relative risk, 4.477; P =.0078) were independent risk factors affecting 1-year graft survival in the PD group. In the PD group, transplant recipients who developed cholestasis (total bilirubin level > or = 5 mg/dL on postoperative day 7) had longer warm (WITs) and cold ischemic times (CITs). Transplant recipients with a DLW/ERLW less than 0.4 had a trend toward a greater incidence of HAT (40%; P <.06), septicemia (60%), and decreased 1- and 5-year graft survival rates (40% and 20%; P =.08 and.07 v DLW/ERLW of 0.4 or greater, respectively). In conclusion, the use of PD livers for adult recipients was associated with a greater risk for developing HAT. The outcome of small-for-size grafts is more likely to be adversely affected by longer WITs and CITs. The safe limit of graft volume appeared to be a DLW/ERLW of 0. 4 or greater.
尽管存在尺寸差异，但在某些情况下，小儿供体（PD）肝脏已被分配给成人移植受者。我们比较了接受原发性肝移植的成人（年龄≥19岁）的数据，这些成人使用的肝脏来自PD（年龄<13岁；n = 70）或成人供体（AD；年龄≥19岁；n = 1,051）。我们还调查了延长胆汁淤积的危险因素及其对PD组生存的影响。为了确定最小移植物体积要求，我们根据供体肝脏重量（DLW）与估计受体肝脏重量（ERLW）的比例，在两个不同的临界值下将PD组分为2个亚组：小于0.4（n = 5）与0.4或更高（n = 56），以及小于0.5（n = 21）与0.5或更高（n = 40）。与AD组（3.8%；P =.0003）相比，PD组肝动脉血栓形成（HAT）的发生率显著更高（12.9%）。多变量分析显示，术前凝血酶原时间为16秒或更长（相对风险，3.206；P =.0115）以及未使用FK506作为主要免疫抑制剂（相对风险，4.477；P =.0078）是影响PD组1年移植物存活的独立危险因素。在PD组中，发生胆汁淤积（术后第7天总胆红素水平≥5 mg/dL）的移植受者有更长的热缺血时间（WITs）和冷缺血时间（CITs）。DLW/ERLW小于0.4的移植受者有HAT发生率更高（40%；P <.06）、败血症发生率更高（60%）以及1年和5年移植物存活率降低（40%和20%；分别与DLW/ERLW为0.4或更高相比，P =.08和.07）的趋势。总之，将PD肝脏用于成人受者与发生HAT的风险更高相关。小体积移植物的结果更可能受到更长WITs和CITs的不利影响。移植物体积的安全限度似乎是DLW/ERLW为0.4或更高。
