Yilmaz Aygen, Arikan Cigdem, Tumgor Gokhan, Kilic Murat, Aydogdu Sema
Liver Transplant Group, Department of Pediatric Gastroenterology, Akdeniz University Solid Organ Transplant Center, Antalya, Turkey.
Pediatr Transplant. 2007 Mar;11(2):160-4. doi: 10.1111/j.1399-3046.2006.00601.x.
The aim of the study was to assess early and long-term incidence of venous complications, in both deceased donation (DD) and living-related (LR) liver transplantation (LT) in a pediatric population. Seventy-five liver transplants performed in 69 (39 boys, 30 girls) children at Ege University Hospital between 1997 and 2004 were prospectively monitored and reviewed. Age, sex, primary diagnosis, graft type, vascular complications and their management were evaluated. All patients received Doppler ultrasonographic examination both during operation and daily for the first three postoperative days and when necessary thereafter. The complications were classified as early and late presented. Thirty-three grafts (47.8%) were from DD and 36 (52.2%) were from LR donors. Recipients of DD were older than LR donors (mean age 10.5 +/- 5.1 and 5.0 +/- 0.7, respectively) (p < 0.05). Vascular complication occurrence was not statistically different between DDLT and LRLT recipients (p = 0.2), and between infants and children (p = 0.9). Overall, stenosis was more common than thrombosis. We observed hepatic artery (HA) thrombosis, in five of 75 (6.7%) transplants within 30 days post-transplant. Portal vein (PV) thrombosis and hepatic vein (HV) thrombosis were detected in six and one patients (8.7% and 1.3%), respectively. Six PV stenosis were identified (8.7%), while HA and HV-VC (vena cava) stenosis occurred in one and six patients (1.4% and 8.7%), respectively. All PV stenosis (6/33, 18.2%) and one PV aneurysm occurred in DDLT recipients while HV-VC stenosis were detected almost equally in LRLT and DDLT recipients (4/36 vs. 2/33). Except one, all PV stenosis were detected as a late complication and no intervention were needed. Stenosis of HV-VC was more common in girls (5/30 vs. 1/39) (p < 0.05) and the incidence was not different in DDLT and LRLT recipients (p = 0.8). In conclusion, overall incidences of thrombosis and stenosis formation after orthotopic liver transplantation (OLT) were 17.4% and 18.8%, respectively in our center. We suggest that in the cases with HA thrombosis manifested intra-operatively or within the early postoperative period, graft salvage was successful. Thrombosis of HA causes significant mortality. Thrombosis of PV was among the causes of mortality and morbidity. Stenosis of HV-VC could be managed by angioplasty and endovascular stenting with no significant effect to mortality.
本研究的目的是评估小儿群体中死体供肝（DD）和活体亲属供肝（LR）肝移植（LT）术后静脉并发症的早期和长期发生率。1997年至2004年间，在伊兹密尔艾杰大学医院对69名（39名男孩，30名女孩）儿童进行的75例肝移植手术进行了前瞻性监测和回顾。评估了年龄、性别、原发诊断、移植物类型、血管并发症及其处理情况。所有患者在手术期间及术后前三天每天接受多普勒超声检查，必要时术后也进行检查。并发症分为早期和晚期出现的。33例移植物（47.8%）来自DD供体，36例（52.2%）来自LR供体。DD供体的受者比LR供体的受者年龄大（平均年龄分别为10.5±5.1岁和5.0±0.7岁）（p<0.05）。DDLT和LRLT受者之间血管并发症的发生率无统计学差异（p = 0.2），婴儿和儿童之间也无差异（p = 0.9）。总体而言，狭窄比血栓形成更常见。我们观察到75例移植中有5例（6.7%）在移植后30天内发生肝动脉（HA）血栓形成。门静脉（PV）血栓形成和肝静脉（HV）血栓形成分别在6例和1例患者中检测到（8.7%和1.3%）。发现6例PV狭窄（8.7%），而HA和HV-腔静脉（VC）狭窄分别发生在1例和6例患者中（1.4%和8.7%）。所有PV狭窄（6/33，18.2%）和1例PV动脉瘤发生在DDLT受者中，而HV-VC狭窄在LRLT和DDLT受者中检测到的情况几乎相同（4/36对2/33）。除1例以外，所有PV狭窄均作为晚期并发症被检测到，且无需干预。HV-VC狭窄在女孩中更常见（5/30对1/39）（p<0.05），在DDLT和LRLT受者中的发生率无差异（p = 0.8）。总之，在我们中心，原位肝移植（OLT）后血栓形成和狭窄形成的总体发生率分别为17.4%和18.8%。我们建议，对于术中或术后早期出现HA血栓形成的病例，移植物挽救是成功的。HA血栓形成会导致显著的死亡率。PV血栓形成是死亡和发病的原因之一。HV-VC狭窄可通过血管成形术和血管内支架置入术进行处理，对死亡率无显著影响。
