Farmer Douglas G, Venick Robert S, McDiarmid Sue V, Ghobrial Rafik M, Gordon Sherilyn A, Yersiz Hasan, Hong Johnny, Candell Leah, Cholakians Argine, Wozniak Laura, Martin Martin, Vargas Jorge, Ament Marvin, Hiatt Jonathan, Busuttil Ronald W
Department of Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90095-7054, USA.
J Am Coll Surg. 2007 May;204(5):904-14; discussion 914-6. doi: 10.1016/j.jamcollsurg.2007.01.061.
Pediatric liver transplantation (PLTx) is the standard of care for treatment of liver failure in children. Unfortunately, there are few studies with substantial numbers of patients that identify outcomes predictors. The goal of this study was to determine factors that influence outcomes in a large, single-center cohort of PLTx.
This retrospective review between 1984 to 2006 included all recipients 18 years of age and younger undergoing PLTx. Multiorgan graft recipients were excluded (n = 48). Data sources included transplantation center database and hospital medical records. Outcomes measures were overall patient and graft survival. Demographic, laboratory, and perioperative variables were analyzed. Univariate and multivariate statistical analysis was undertaken using log-rank test and Cox's proportional hazards model. A p value < 0.05 was considered significant at the multivariate level.
Eight hundred fifty-two PLTx were performed in 657 children; 55% were girls, 45% were Hispanic, and median age was 29.5 months. Biliary atresia and acute liver failure were the most common causes of liver disease. Fifty-two percent were hospitalized before PLTx. Graft types were whole (75%) and segmental (25%). Indications for re-PLTx (n = 195) included graft nonfunction (22%), immunologic (34%), and vascular complications (35%). Overall 1-, 5-, and 10-year survival rates were 85%, 81%, and 78% (patient), and 78%, 72%, and 67% (graft). Independent significant predictors of worse patient survival were renal function, pretransplantation ventilator dependence, and causes of liver disease. Independent significant predictors of worse graft survival were renal function and warm ischemia time.
As one of the largest, single-center analyses of PLTx, this study enables accurate statistical analysis and demonstrates excellent longterm outcomes. Independent prognosticators of graft survival were renal function and warm ischemia time, and those for patient survival were renal function, mechanical ventilation, and causes of liver disease. These factors can aid in the medical decision making required for optimal use of scarce donor organs.
小儿肝移植（PLTx）是治疗儿童肝衰竭的标准治疗方法。不幸的是，很少有大量患者的研究能确定预后预测因素。本研究的目的是确定在一个大型单中心小儿肝移植队列中影响预后的因素。
这项1984年至2006年的回顾性研究纳入了所有接受PLTx的18岁及以下受者。多器官移植受者被排除（n = 48）。数据来源包括移植中心数据库和医院病历。结局指标为患者和移植物的总体生存率。对人口统计学、实验室和围手术期变量进行了分析。采用对数秩检验和Cox比例风险模型进行单变量和多变量统计分析。多变量水平上p值<0.05被认为具有统计学意义。
657名儿童接受了852例PLTx；55%为女孩，45%为西班牙裔，中位年龄为29.5个月。胆道闭锁和急性肝衰竭是最常见的肝病病因。52%的患者在PLTx前住院。移植物类型为全肝（75%）和部分肝（25%）。再次PLTx（n = 195）的指征包括移植物无功能（22%）、免疫因素（34%）和血管并发症（35%）。总体1年、5年和10年生存率分别为85%、81%和78%（患者），以及78%、72%和67%（移植物）。患者生存较差的独立显著预测因素是肾功能、移植前呼吸机依赖和肝病病因。移植物生存较差的独立显著预测因素是肾功能和热缺血时间。
作为最大规模的单中心小儿肝移植分析之一，本研究能够进行准确的统计分析，并显示出优异的长期结局。移植物生存的独立预后因素是肾功能和热缺血时间，患者生存的独立预后因素是肾功能、机械通气和肝病病因。这些因素有助于在最佳利用稀缺供体器官所需的医疗决策中发挥作用。
