Asthana Sonal, McClean Patricia, Stringer Mark D
Children's Liver and GI Unit, Gledhow Wing, St James's University Hospital, Leeds, LS9 7TF, UK.
Pediatr Surg Int. 2006 Sep;22(9):697-700. doi: 10.1007/s00383-006-1737-1. Epub 2006 Aug 1.
The pediatric end-stage liver disease score (PELD) was devised and validated as a tool for predicting mortality and morbidity in children with chronic liver disease waiting for a liver transplant (LT). It has become a useful guide for prioritizing organ allocation in the United States. The hepatic artery resistance index (HARI) also predicts waiting list mortality in children with biliary atresia. Does the PELD score or HARI predict outcome after LT for biliary atresia? Twenty consecutive children who underwent LT for biliary atresia between 2001 and 2005 were reviewed. Their PELD score was calculated periodically between listing and transplantation and HARI was measured at listing. Outcome variables were operative blood transfusion requirements, ICU stay and postoperative stay. Median age at LT was 8 (2-204) months. After allowing for the type of graft, the PELD score and the change in PELD score between listing and LT (deltaPELD) showed no significant correlation with blood transfusion requirements, but both the PELD score at listing and deltaPELD showed a trend toward a statistically significant positive correlation with overall hospital stay. Pre-transplant HARI showed a statistically significant positive correlation with the PELD score at listing (r = 0.46, p = 0.05) but did not correlate significantly with hospital stay. In this relatively small but homogeneous group of children undergoing LT for biliary atresia, PELD, and deltaPELD scores showed a trend toward a statistically significant positive correlation with overall hospital stay. However, neither PELD scores nor the pre-transplant HARI showed a definite correlation with outcome. Post-transplant complications are probably more important factors determining ICU and hospital stay in children currently transplanted for biliary atresia.
小儿终末期肝病评分（PELD）被设计并验证为预测等待肝移植（LT）的慢性肝病患儿死亡率和发病率的工具。它已成为美国器官分配优先排序的有用指南。肝动脉阻力指数（HARI）也可预测胆道闭锁患儿在等待名单上的死亡率。PELD评分或HARI能否预测胆道闭锁患儿LT后的结局？回顾了2001年至2005年间连续接受LT治疗的20例胆道闭锁患儿。在列入名单至移植期间定期计算他们的PELD评分，并在列入名单时测量HARI。结局变量包括手术输血需求、ICU住院时间和术后住院时间。LT时的中位年龄为8（2 - 204）个月。在考虑移植物类型后，PELD评分以及列入名单至LT期间PELD评分的变化（deltaPELD）与输血需求无显著相关性，但列入名单时的PELD评分和deltaPELD均显示出与总体住院时间呈统计学显著正相关的趋势。移植前HARI与列入名单时的PELD评分呈统计学显著正相关（r = 0.46，p = 0.05），但与住院时间无显著相关性。在这组相对较小但同质性较高的接受LT治疗的胆道闭锁患儿中，PELD和deltaPELD评分显示出与总体住院时间呈统计学显著正相关的趋势。然而，PELD评分和移植前HARI均未显示出与结局有明确的相关性。移植后并发症可能是目前接受移植的胆道闭锁患儿ICU和住院时间的更重要决定因素。
