Karakayali H, Ozcay F, Sevmis S, Savas N, Haberal M
Department of General Surgery, Başkent University Faculty of Medicine, Ankara, Turkey.
Transplant Proc. 2007 May;39(4):1153-6. doi: 10.1016/j.transproceed.2007.02.054.
Orthotopic liver transplantation remains a major medical and surgical challenge in small pediatric patients. From April 2003 to June 2006, 21 small babies (each of whom weighed less than 10 kg or was younger than 1 year of age) underwent orthotopic liver transplantation. Five were girls and 16 were boys with a mean age of 15.7 +/- 9.3 months (range, 2-24 months); their mean weight at the time of transplantation was 9.8 +/- 3.6 kg (range, 6-16 kg). All transplants were obtained from a living-related donor. Left lateral segment was used for all transplantations. The median graft-to-recipient weight ratio was 3.5% +/- 1.2% (range, 1.5%-6.1%). During the early postoperative period, hepatic arterial thrombosis was identified in 4 patients, and a biliary leak was detected in 2 patients. In 2 patients, portal vein stenosis was identified during the late postoperative period. At the time of this writing, the 17 alive patients (81%) exhibited good graft function at median follow-up of 14.8 +/- 10.9 months (range, 1-39 months). Four patients died during the follow-up. Histological examination revealed hepatocellular carcinoma in 2 patients, and Burkitt's lymphoma in 1 patient. In conclusion, our data confirmed that living-related donors, especially in this age group, provide a reliable source for the organ pool. Satisfactory results can be achieved despite the anatomic handicaps of this age group.
原位肝移植对于小儿患者来说仍然是一项重大的医学和外科挑战。2003年4月至2006年6月，21名小婴儿（每名体重不足10公斤或年龄小于1岁）接受了原位肝移植。其中5名是女孩，16名是男孩，平均年龄为15.7±9.3个月（范围为2 - 24个月）；移植时他们的平均体重为9.8±3.6公斤（范围为6 - 16公斤）。所有移植均采用活体亲属供体。所有移植均使用左外叶。移植肝与受体体重比的中位数为3.5%±1.2%（范围为1.5% - 6.1%）。术后早期，4例患者发现肝动脉血栓形成，2例患者检测到胆漏。2例患者在术后晚期发现门静脉狭窄。在撰写本文时，17名存活患者（81%）在中位随访14.8±10.9个月（范围为1 - 39个月）时移植肝功能良好。4例患者在随访期间死亡。组织学检查显示2例患者患有肝细胞癌，1例患者患有伯基特淋巴瘤。总之，我们的数据证实，活体亲属供体，尤其是在这个年龄组，为器官库提供了可靠的来源。尽管这个年龄组存在解剖学上的不利因素，但仍可取得满意的结果。
