Barshes Neal R, Lee Timothy C, Balkrishnan Rajesh, Karpen Saul J, Carter Beth A, Goss John A
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Liver Transpl. 2005 Oct;11(10):1193-200. doi: 10.1002/lt.20509.
Biliary atresia is the most common indication for orthotopic liver transplantation (OLT) in the pediatric population. The outcomes of liver transplantation for biliary atresia, however, have not been formally examined on a national scale. The objective of this study was to identify pretransplant variables that predict patient survival after primary liver transplantation for biliary atresia. A cohort of 1,976 pediatric patients undergoing primary liver transplantation for biliary atresia between 1/1988 to 12/2003 was enrolled from the United Network for Organ Sharing database after excluding patients with a history of multiorgan transplant or previous liver transplant. Follow-up data up to 16 years post-OLT was available. The 5- and 10-year actuarial survival rates of patients that underwent liver transplantation for biliary atresia in the United States are 87.2% and 85.8%, respectively, and the 5- and 10-year graft actuarial survival rates are 76.2% and 72.7%, respectively. Early deaths (< or =90 days post-OLT) were more often caused by graft failure (P = 0.01), whereas late deaths (>90 days post-OLT) were more often due to malignancy (P < 0.01). An analysis of outcomes over time demonstrated a decrease in post-OLT survival and an increase in the number of OLTs done for biliary atresia at an increasing number of centers. A multivariate analysis revealed that cadaveric partial/reduced liver grafts, a history of life support at the time of OLT, and decreased age were independent predictors of increased post-OLT mortality. In conclusion, OLT is an effective treatment for biliary atresia. Certain pretransplant variables may help predict patient survival following liver transplantation for biliary atresia.
胆道闭锁是儿童群体中进行原位肝移植（OLT）最常见的适应症。然而，针对胆道闭锁进行肝移植的结局尚未在全国范围内进行正式研究。本研究的目的是确定预测胆道闭锁初次肝移植术后患者生存的移植前变量。在排除有多器官移植史或既往肝移植史的患者后，从器官共享联合网络数据库中纳入了1988年1月至2003年12月期间因胆道闭锁接受初次肝移植的1976名儿科患者队列。可获得OLT术后长达16年的随访数据。在美国，因胆道闭锁接受肝移植患者的5年和10年精算生存率分别为87.2%和85.8%，5年和10年移植物精算生存率分别为76.2%和72.7%。早期死亡（OLT术后≤90天）更常由移植物衰竭引起（P = 0.01），而晚期死亡（OLT术后>90天）更常归因于恶性肿瘤（P < 0.01）。对不同时间结局的分析表明，OLT术后生存率下降，且越来越多的中心因胆道闭锁进行OLT的数量增加。多变量分析显示，尸体部分/减体积肝移植物、OLT时的生命支持史以及年龄降低是OLT术后死亡率增加的独立预测因素。总之，OLT是治疗胆道闭锁的有效方法。某些移植前变量可能有助于预测胆道闭锁肝移植术后的患者生存情况。
