Tannuri U, Velhote M C P, Santos M M, Gibelli N E, Ayoub A A, Maksoud-Filho J G, Silva M M, Pinho M L, Miyatani H T, Maksoud J G
Liver Transplantation Unit, Children Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Transplant Proc. 2004 May;36(4):941-2. doi: 10.1016/j.transproceed.2004.03.101.
This study reports the 14-year experience of a single center on 206 liver transplantations from living and cadaveric donors performed in 179 pediatric patients. Biliary atresia (57.2%) and fulminant hepatitis (9.8%) were the most frequent indications. The mean age of the recipients was 3 years, 7 months (9 months to 18 years) and mean weight was 14 kg (7 to 57 kg). The allografts were distributed as 82 (39.8%) whole cadaveric, 76 (36.9%) reduced-size cadaveric, 46 (22.3%) living donor liver transplants, and 2 (0.9%) ex situ split livers. The waiting periods were 25 days for living donors and 2.5 years for cadaveric donors (P <.001). Twenty-seven children were retransplanted with hepatic artery thrombosis the most frequent indication. The postoperative complications were: primary nonfunction (12.2%), biliary stenosis (28.8%), hepatic artery thrombosis (12.2%), portal vein stenosis (4.9%), hepatic vein stenosis (6.9%), and lymphoproliferative disorder (5.9%). The diagnosis of biliary stenosis was obtained by liver biopsy and transhepatic cholangiography and treated by balloon dilatation, although four children (3.9%) required a redo hepaticojejunostomy. The venous stenoses were percutaneously dilated with five-children (4.9%) requiring venous stents. The incidence of hepatic vein stenosis was 15.6% among living donor and 2.5% in cadaveric liver transplantation (P <.05). The overall 5-year patient and graft survivals were 70.2% and 65.1%. Liver transplantation provides excellent long-term survival. The use of grafts from living donors decreases the waiting periods but increases the incidence of hepatic vein stenosis.
本研究报告了一个中心14年来对179例儿科患者进行的206例活体和尸体供肝肝移植的经验。胆道闭锁(57.2%)和暴发性肝炎(9.8%)是最常见的适应证。受者的平均年龄为3岁7个月(9个月至18岁),平均体重为14千克(7至57千克)。同种异体移植物分布为82例(39.8%)全尸体供肝、76例(36.9%)减体积尸体供肝、46例(22.3%)活体供肝肝移植和2例(0.9%)体外劈裂肝。活体供肝的等待期为25天,尸体供肝为2.5年(P<0.001)。27例儿童因肝动脉血栓形成这一最常见适应证而接受再次移植。术后并发症包括:原发性无功能(12.2%)、胆管狭窄(28.8%)、肝动脉血栓形成(12.2%)、门静脉狭窄(4.9%)、肝静脉狭窄(6.9%)和淋巴增殖性疾病(5.9%)。胆管狭窄通过肝活检和经肝胆管造影确诊,并通过球囊扩张治疗,不过有4例儿童(3.9%)需要再次进行肝空肠吻合术。静脉狭窄通过经皮扩张治疗,5例儿童(4.9%)需要静脉支架。肝静脉狭窄的发生率在活体供肝肝移植中为15.6%,在尸体供肝肝移植中为2.5%(P<0.05)。总体5年患者和移植物存活率分别为70.2%和65.1%。肝移植可提供出色的长期存活。使用活体供肝可缩短等待期,但会增加肝静脉狭窄的发生率。