[利用活体供者的节段性移植物以及尸体供者的减体积或劈裂式移植物扩大小儿肝移植的移植物来源]
[Expanding the grafts pool for pediatric liver transplantation with segmental grafts from living donor and cadaveric reduced size or split grafts].
作者信息
Benhaim M
机构信息
Department of General Surgery and Transplantations, Sheba Medical Center, Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, USA.
出版信息
Harefuah. 2002 Jul;141(7):582-5, 668.
AIM
To compare short and long-term results of pediatric liver transplantation (LT), utilizing segmental grafts from living donors (LD) vs. cadaveric (CAD) reduced size or split grafts.
METHODS
A retrospective analysis of a single center experience (1993-2000), comparing the surgical outcome, the graft function and the survival rates between these groups.
RESULTS
Of 195 LTs in pediatric recipients (age < 18), 48 (25%) were with LD grafts and 47 (24%) with CAD grafts (reduced size, n = 27, or split, n = 20). The mean age and weight of the LD recipients were 1.8 +/- 3 yrs and 9.0 +/- 8.1 kg vs. 3.5 +/- 4 yrs. and 15.2 +/- 14.5 kg in the CAD group. The distribution of etiologies was comparable (EHBA, 54% vs. 49%; inborn errors in metabolism, 12.5% vs. 12%; acute idiopathic hepatic failure, 12.5% vs. 14.2%). The severity of pretransplant disease and the fraction of acute hepatic failure cases were also comparable, although less LD grafts were used for urgent re-transplantation due to primary non-function or vascular complications (1 case in the LD group vs. 6 in the CAD group). The median warm ischemia time was similar (43 min; range, 28-87 min vs. 45 min; range 12-82 min), but the median cold ischemia time was significantly different (60 min; range 43-298 in LD vs. 637 min; range, 342-1102 in CAD grafts). Both patient and graft survival in 3 months, 1 and 5 years were significantly superior in the LD group (patient survival, 97%, 91% and 89% vs. 82%, 70% and 62%, p < 0.001; graft survival, 92%, 89% and 77% vs. 66%, 59% and 52%, p < 0.005). The incidence of vascular complications (hepatic artery or portal vein thrombosis) and biliary complications (leak of stricture) was comparable (vascular, 10% vs. 7%, biliary, 16% vs. 9%). The incidence of poor early graft function (6% vs. 21%) and primary non-function (2% vs. 18%) was significantly lower in the LD group.
CONCLUSION
Although presenting similar surgical complexity, the outcome of segmental grafts from LD is better than of reduced size or split cadaveric grafts.
目的
比较利用活体供体（LD）的节段性移植物与尸体供体（CAD）的缩小体积或劈裂移植物进行小儿肝移植（LT）的短期和长期结果。
方法
对单一中心（1993 - 2000年）的经验进行回顾性分析，比较这些组之间的手术结果、移植物功能和生存率。
结果
在195例小儿肝移植受者（年龄<18岁）中，48例（25%）接受LD移植物，47例（24%）接受CAD移植物（缩小体积，n = 27，或劈裂，n = 20）。LD受者的平均年龄和体重分别为1.8±3岁和9.0±8.1 kg，而CAD组为3.5±4岁和15.2±14.5 kg。病因分布具有可比性（肝外胆管闭锁，54%对49%；代谢性先天性疾病，12.5%对12%；急性特发性肝衰竭，12.5%对14.2%）。移植前疾病的严重程度和急性肝衰竭病例的比例也具有可比性，尽管由于原发性无功能或血管并发症，用于紧急再次移植的LD移植物较少（LD组1例，CAD组6例）。中位热缺血时间相似（43分钟；范围28 - 87分钟对45分钟；范围12 - 82分钟），但中位冷缺血时间有显著差异（LD组为60分钟；范围43 - 298分钟，CAD移植物为637分钟；范围342 - 1102分钟）。LD组在3个月、1年和5年时的患者和移植物生存率均显著更高（患者生存率，97%、91%和89%对82%、70%和62%，p<0.001；移植物生存率，92%、89%和77%对66%、59%和52%，p<0.005）。血管并发症（肝动脉或门静脉血栓形成）和胆道并发症（渗漏或狭窄）的发生率具有可比性（血管，10%对7%，胆道，16%对9%）。LD组早期移植物功能不良（6%对21%）和原发性无功能（2%对18%）的发生率显著更低。
结论
尽管手术复杂性相似，但LD节段性移植物的结果优于缩小体积或劈裂的尸体供体移植物。
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