儿童肝脏再次移植

Retransplantation of the liver in children.

作者信息

Sieders E, Peeters P M, TenVergert E M, de Jong K P, Porte R J, Zwaveling J H, Bijleveld C M, Slooff M J

机构信息

Liver Transplant Group, University Hospital Groningen, The Netherlands.

出版信息

Transplantation. 2001 Jan 15;71(1):90-5. doi: 10.1097/00007890-200101150-00015.

DOI:10.1097/00007890-200101150-00015

PMID:11211202

Abstract

BACKGROUND

Because of the poor outcome of hepatic retransplantation, it is still debated whether this procedure should be performed in an era of donor organ scarcity. The aim of this study was to analyze outcome of hepatic retransplantation in children, to identify risk factors influencing this outcome, and to assess morbidity and causes of death.

METHODS

A series of 97 children after a single transplantation and 34 children with one retransplantation was analyzed.

RESULTS

The 1-, 3-, and 5-year survival of children with a retransplantation was 70, 63, and 52%, respectively, compared with 85, 82, and 78%, respectively, for children after a single transplantation (P=0.009). Survival of children with a retransplantation within 1 month after primary transplantation was worse (P=0.007) and survival of children with a late retransplantation was comparable (P=0.66) with single transplantation. In early retransplantations, the Child-Pugh score was higher, donors were older and weighed more, and more technical variant liver grafts were used compared with single transplantations. Biliary atresia and a high Child-Pugh score were associated with decreased patient survival after retransplantation. Sepsis was the most important complication and cause of death after retransplantation.

CONCLUSIONS

Retransplantation is a significant event after pediatric liver transplantation. Outcome after hepatic retransplantation in children is inferior compared with single transplantation. This difference is explained by low survival after early retransplantation and can be explained by the poor clinical condition of the children at time of retransplantation, especially in children with biliary atresia, and by the predominant use of technical variant liver grafts in retransplantations.

摘要

背景

由于肝再次移植的效果不佳，在供体器官短缺的时代，是否应进行该手术仍存在争议。本研究的目的是分析儿童肝再次移植的结果，确定影响该结果的危险因素，并评估发病率和死亡原因。

方法

分析了97例单次移植后的儿童和34例接受一次再次移植的儿童。

结果

再次移植儿童的1年、3年和5年生存率分别为70%、63%和52%，而单次移植儿童的相应生存率分别为85%、82%和78%（P=0.009）。初次移植后1个月内进行再次移植的儿童生存率较差（P=0.007），而晚期再次移植儿童的生存率与单次移植相当（P=0.66）。与单次移植相比，早期再次移植时，儿童终末期肝病评分系统（Child-Pugh）评分更高，供体年龄更大、体重更重，且使用了更多技术变异的肝移植物。胆管闭锁和高Child-Pugh评分与再次移植后患者生存率降低相关。脓毒症是再次移植后最重要的并发症和死亡原因。