Kelly Deirdre, Sibal Anupam
The Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham.
Indian J Pediatr. 2003 Sep;70(9):731-6. doi: 10.1007/BF02724316.
Liver transplantation is accepted therapy for acute or chronic liver failure. Survival after LT has improved significantly in developed countries and this has increased the awareness of this treatment modality in the developing world. Successful LT in both children and adults have now been reported from India. Chronic liver failure secondary to cholestatic liver disease in the most frequent indication for LT, with biliary with atresia as the single commonest cause. Innovative techniques such as reduced size, splint, and living donor liver transplantation are being applied more often to decrease long waiting times and reduce associated morbidity and mortality. Early postoperative complications include primary graft failure, venous thrombosis, rejection, biliary complications and infections. Late complication includes CMV or EBV infections, side effects of immunosuppression, post transplantation lymphoproliferative disease and late biliary strictures. Most children achieve good quality of life. There are still many lessons to learn and there are future challenges such as the ever increasing problems of donor scarcity and the search for potent but less toxic immunosuppressive agents.
肝移植是治疗急性或慢性肝衰竭的公认疗法。在发达国家，肝移植后的生存率有了显著提高，这也提高了发展中国家对这种治疗方式的认识。印度现已报道了儿童和成人肝移植均取得成功的案例。胆汁淤积性肝病继发的慢性肝衰竭是肝移植最常见的适应证，其中胆道闭锁是最常见的单一病因。诸如减体积肝移植、劈裂式肝移植和活体供肝肝移植等创新技术正越来越频繁地应用于减少长时间等待，并降低相关的发病率和死亡率。术后早期并发症包括原发性移植肝无功能、静脉血栓形成、排斥反应、胆道并发症和感染。晚期并发症包括巨细胞病毒或EB病毒感染、免疫抑制的副作用、移植后淋巴增殖性疾病和晚期胆道狭窄。大多数儿童都能获得良好的生活质量。仍有许多经验教训需要汲取，未来也面临诸多挑战，如供体短缺问题日益严重，以及寻找强效但毒性较小的免疫抑制剂。
