Cintorino D, Spada M, Clarizia S, Vasta F, Mandalà L, Aricò M, Traverso G, Luca A, Panarello G, Minervini M, Gruttadauria S, Verzaro R, Volpes R, Scotti Foglieni C, Gridelli B
Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (IsMeTT), Palermo, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2597-8. doi: 10.1016/j.transproceed.2005.06.017.
Between July 2003 and November 2004 14 pediatric liver transplantations (LTx) have been performed in 12 children using cadaveric donors. The primary diseases were as follows biliary atresia in 9 cases, whereas the other 3 children were affected by cystic fibrosis, Langherans cells histiocytosis, and hepatoblastoma, respectively. Median patient waiting time was 103 days (range, 2-158); no patient died while on the waiting list. Patients who underwent transplantation included 7 boys and 5 girls, ranging in age from 6 months to 14 years (median age, 5 years). Recipient median weight was 16 kg (range, 6-38). Donor median age was 19 years (range, 3-47), whereas donor median weight was 74 kg (range, 15-90). All children who underwent primary LTx were United Network for Organ Sharing (UNOS) status 2B. Of the 12 transplanted patients, 9 received a left lateral segment (LLS) from an in situ split liver, whereas 3 received a whole graft. Two children developed an episode of acute cellular rejection on the seventh postoperative day, which was treated successfully with a course of intravenous steroids for 3 days. After a median follow-up of 245 days, 10 children are alive but 2 children died due to primary nonfunction (PNF) on the second postoperative day and septic shock on the fifth postoperative day after retransplantation for acute hepatic artery thrombosis, respectively. One child who underwent retransplantation for hepatic artery thrombosis on the 31st postoperative day after primary LTx is currently alive. Evaluation of our initial data suggests that the split liver technique has the potential to meet the needs of pediatric LTx allowing grafting early in the course of the original disease and reducing waiting time.
2003年7月至2004年11月期间，12名儿童接受了14例尸体供肝的小儿肝移植手术。主要疾病如下：9例为胆道闭锁，另外3例儿童分别患有囊性纤维化、朗格汉斯细胞组织细胞增多症和肝母细胞瘤。患者的中位等待时间为103天（范围为2至158天）；等待名单上无患者死亡。接受移植的患者包括7名男孩和5名女孩，年龄从6个月至14岁不等（中位年龄为5岁）。受者的中位体重为16千克（范围为6至38千克）。供者的中位年龄为19岁（范围为3至47岁），供者的中位体重为74千克（范围为15至90千克）。所有接受初次肝移植的儿童均为器官共享联合网络（UNOS）2B级状态。12例移植患者中，9例接受了原位劈离肝的左外叶，3例接受了全肝移植。2例儿童在术后第7天发生急性细胞排斥反应，经静脉注射类固醇治疗3天成功治愈。中位随访245天后，10名儿童存活，但2名儿童分别在术后第2天因原发性无功能（PNF）和在再次移植治疗急性肝动脉血栓形成术后第5天因感染性休克死亡。1例在初次肝移植术后第31天因肝动脉血栓形成接受再次移植的儿童目前存活。对我们初始数据的评估表明，劈离肝技术有可能满足小儿肝移植的需求，允许在原发病病程早期进行移植并减少等待时间。
