Visser Brendan C, Suh Insoo, Hirose Shinjiro, Rosenthal Philip, Lee Hanmin, Roberts John P, Hirose Ryutaro
The University of California, San Francisco, CA, USA.
Liver Transpl. 2004 Oct;10(10):1279-86. doi: 10.1002/lt.20234.
After portoenterostomy (PE) for biliary atresia (BA), many patients suffer progressive deterioration of liver function and ultimately require liver transplantation. We retrospectively reviewed a single center's experience with pediatric liver transplantation for BA from 1988 to 2002. Sixty-six patients underwent 69 liver transplants for BA. Forty-two (63%) patients had previously undergone Kasai PE, 11 (17%) biliary appendicoduodenostomy (BAD), and 13 (20%) had no prior biliary drainage (NBD). The BAD procedure offered only short-term biliary drainage--the mean interval between PE and transplant was more than twice that for Kasai patients than for BAD patients (132 versus 49 weeks). The transplants included 11 cadaveric partial, 27 cadaveric whole, and 31 living related transplants. Three patients required retransplant. Prior PE did not increase the incidence of major perioperative complications or unplanned reexploration. After transplant, the 1-, 5-, and 10-year actuarial graft survival rates were 87%, 86%, and 80%, respectively. The 1-, 5-, and 10-year actuarial patient survival rates were 91%, 89%, and 83%. PE remains an important bridge to transplant. In conclusion, transplantation for BA offers excellent long-term graft and patient survival.
对于胆道闭锁（BA）患者，在进行肝门空肠吻合术（PE）后，许多患者会出现肝功能进行性恶化，最终需要进行肝移植。我们回顾性分析了1988年至2002年单中心小儿BA肝移植的经验。66例患者接受了69次BA肝移植。42例（63%）患者此前接受过Kasai PE，11例（17%）接受过胆肠吻合术（BAD），13例（20%）未进行过先前的胆道引流（NBD）。BAD手术仅提供短期胆道引流——PE与移植之间的平均间隔时间，Kasai患者比BAD患者长两倍多（132周对49周）。移植包括11例尸体部分肝移植、27例尸体全肝移植和31例亲属活体肝移植。3例患者需要再次移植。先前的PE并未增加围手术期主要并发症或计划外再次探查的发生率。移植后，1年、5年和10年的移植精算生存率分别为87%、86%和80%。1年、5年和10年的患者精算生存率分别为91%、89%和83%。PE仍然是移植的重要桥梁。总之，BA肝移植可实现出色的长期移植和患者生存。
Zotero 插件