Wallot Michael A, Mathot Michael, Janssen Magda, Hölter Tanja, Paul Kilic, Buts Jean Paul, Reding Raymond, Otte Jean Bernard, Sokal Etienne M
Department of Pediatric Transplantation, Saint Luc Clinic, Catholic University of Louvain, Brussels, Belgium.
Liver Transpl. 2002 Jul;8(7):615-22. doi: 10.1053/jlts.2002.34149.
Increasing numbers of children undergo successful liver transplantation. Limited data exist on long-term survival and late graft loss. Survival and graft loss were studied in 376 primary liver graft recipients who survived more than 3 months after transplantation (80.5% of all primary graft recipients). Patient records were reviewed retrospectively for causes of graft loss. Risk factors were identified by analyzing graft, recipient, and posttransplant variables using multivariate Cox regression. One-, 5-, and 10-year actuarial graft survival rates in the study population were 94.6%, 87.3%, and 86.3%, respectively. Corresponding patient survival rates were 95.7%, 91.4%, and 90.4%. Forty-seven (12.5%) grafts were lost subsequently, 15 by patient death with preserved graft function. Survival rate after late retransplantation was 63.3%. Causes of late graft loss were infection (21.2%), posttransplant lymphoproliferative disease (PTLD, 21.2%), chronic rejection (17%), biliary complications (14.8%), and recurrence of malignant disease (8.5%). Independent risk factors for late graft loss and patient death included liver malignancy as primary disease, steroid resistant rejection, and PTLD. Graft loss rate was significantly increased for reduced-size grafts. Patients undergoing transplantation after 1991 and recipients of full-size grafts were more likely to survive. In conclusion, the long-term outcome for pediatric primary liver graft recipients surviving the early postoperative period is excellent except for patients with liver malignancy. There is no increased risk of late graft loss with the use of split or living related donor grafts. Technical complications are only a minor factor in late graft loss, but complications related to immunosuppression and infection remain a major hazard and must be addressed.
越来越多的儿童成功接受肝脏移植。关于长期生存率和晚期移植物丢失的资料有限。对376例移植后存活超过3个月的初次肝移植受者（占所有初次移植受者的80.5%）的生存情况和移植物丢失情况进行了研究。回顾性查阅患者记录以了解移植物丢失的原因。通过多变量Cox回归分析移植物、受者和移植后变量来确定危险因素。研究人群中1年、5年和10年的精算移植物生存率分别为94.6%、87.3%和86.3%。相应的患者生存率分别为95.7%、91.4%和90.4%。随后有47例（12.5%）移植物丢失，其中15例因患者死亡但移植物功能保留。再次移植后的生存率为63.3%。晚期移植物丢失的原因包括感染（21.2%）、移植后淋巴细胞增生性疾病（PTLD，21.2%）、慢性排斥反应（17%）、胆道并发症（14.8%）和恶性疾病复发（8.5%）。晚期移植物丢失和患者死亡的独立危险因素包括原发性肝脏恶性肿瘤、类固醇抵抗性排斥反应和PTLD。减体积移植物的移植物丢失率显著增加。1991年后接受移植的患者和全尺寸移植物受者更有可能存活。总之，除了患有肝脏恶性肿瘤的患者外，小儿初次肝移植受者术后早期存活的长期预后良好。使用劈裂式或亲属活体供肝移植物不会增加晚期移植物丢失的风险。技术并发症只是晚期移植物丢失的一个次要因素，但与免疫抑制和感染相关的并发症仍然是主要危害，必须加以解决。
