Mekeel Kristin L, Langham Max R, Gonzalez-Peralta Regino P, Hemming Alan W
Division of Transplantation and Hepatobiliary Surgery, University of Florida, Gainesville, FL 32410, USA.
Pediatr Transplant. 2007 Feb;11(1):66-72. doi: 10.1111/j.1399-3046.2006.00610.x.
This study examines the results of liver transplantation (LT) in children 5 kg or less. Reports suggest an increased morbidity and mortality in children weighing 5 kg or less as compared to larger children. However, over half of all children needing LT are <1 year old. Improving outcomes in very small children is a major goal of liver transplantation.
All children under 21 years of age transplanted from January 1990 to June 2005 were included in this study. One hundred sixty-eight primary liver transplants were done: 61 in children less than one year of age and 20 in infants weighing 5 kg or less at LT (2 to 5 kg). These 20 infants underwent 23 transplants. Whole organs were used in 39% of transplants, and reduced or split grafts were used in 61%. Arterial reconstruction using aortic conduits was done in 22%. Analysis included Fischer's exact or Chi square test for non-parametric analysis while patient survival was calculated using the Kaplan-Meier method test with differences in survival assessed using the log rank test.
Five-year survival for infants 5 kg or less was 74%, and graft survival was 60%, which was not different from patients transplanted that were >5 kg. There were three perioperative deaths, one from primary graft non-function, and two from portal vein thrombosis. There were no bile leaks or hepatic artery thromboses. Bacterial, fungal, and viral infections made up the vast majority of the postoperative complications (65%), with viral infections resulting in two graft losses requiring re-transplantation. Rejection occurred in 25% of patients, of which one required OKT3. Five of the 23 liver transplants in infants less than 5 kg were done prior to 1996, with a five-year graft survival of only 20%. Improvements in technique and postoperative care after 1996 led to improved graft and patient survival of 77% and 86% respectively.
Liver transplantation for infants weighing less than 5 kilograms can be technically challenging but can have equivalent graft and patient survival when compared to larger children requiring liver transplantation. Infants should not be denied liver transplantation based on weight alone.
本研究调查了体重5千克及以下儿童的肝移植（LT）结果。报告显示，与年龄稍大儿童相比，体重5千克及以下儿童的发病率和死亡率有所增加。然而，所有需要肝移植的儿童中，超过半数年龄小于1岁。改善极小儿童的肝移植结果是肝移植的一个主要目标。
本研究纳入了1990年1月至2005年6月期间接受移植的所有21岁以下儿童。共进行了168例原位肝移植：61例为1岁以下儿童，20例为肝移植时体重5千克及以下的婴儿（2至5千克）。这20例婴儿接受了23次移植。39%的移植使用了全肝，61%使用了减体积或劈离式移植物。22%的移植使用主动脉管道进行动脉重建。分析采用Fischer精确检验或卡方检验进行非参数分析，患者生存率采用Kaplan-Meier方法计算，生存差异采用对数秩检验评估。
体重5千克及以下婴儿的5年生存率为74%，移植物生存率为60%，与体重超过5千克的移植患者无差异。围手术期死亡3例，1例死于原发性移植物无功能，2例死于门静脉血栓形成。无胆漏或肝动脉血栓形成。细菌、真菌和病毒感染占术后并发症的绝大多数（65%）。病毒感染导致2例移植物失功需要再次移植。25%的患者发生排斥反应，其中1例需要使用OKT3。5千克以下婴儿的23例肝移植中有5例在1996年之前进行，5年移植物生存率仅为20%。1996年之后技术和术后护理的改善使移植物和患者生存率分别提高到77%和86%。
体重小于5千克婴儿的肝移植在技术上具有挑战性，但与需要肝移植的较大儿童相比，移植物和患者生存率相当。不应仅基于体重而拒绝婴儿进行肝移植。
