Pirenne J, Aerts R, Monbaliu D, Coosemans W, Vlasselaers D, Desmet L, Herman J, Hoffman I, Lombaerts R
Abdominal Transplant Surgery Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Transplant Proc. 2007 Oct;39(8):2672-4. doi: 10.1016/j.transproceed.2007.08.005.
It is controversial whether pediatric liver transplantation (OLT) should only be performed in a high-volume pediatric or in mixed adult/pediatric centers. We reviewed pediatric OLT results in an originally adult OLT center.
METHODS/RESULTS: Our adult OLT program was initiated in 1989, currently transplanting approximately 55 livers/year. A pediatric OLT program was launched in 1999. Pre- and posttransplant follow-up is multidisciplinary. In the study period, 26 OLT were performed in 25 patients (6% of all OLT; n = 430). The mean age was 8 years (range: 1 month to 18 years). Mean weight was 22 kg (4 to 80 kg). The indications were: acute liver failure in one (4%); chronic liver failure in 25 (96%)-10 metabolic, six biliary atresia, five polycystic/liver fibrosis, four other, and one retransplant. Nine (35%) received partial graft; 5 (19%) multivisceral grafts (liver-kidney, liver-bowel) and 12 (46%), conventional OLT. In all small-weight children, microsurgery was used. Immunosuppression included calcineurin inhibitors (cyclosporine/tacrolimus), azathioprine/mycophenolate mofetil, low-dose steroid, and anti-interleukin-2 receptor in 14. Early hepatic artery thrombosis (HAT), portal vein thrombosis, and primary nonfunction were not encountered. One retransplantation (4%) was done at 4 years posttransplantation for late HAT. Three biliary complications (11%) were encountered at 2 weeks, 4 months, and 2 years. Percentage of early acute and chronic rejections were 7.7% and 0%. Three deaths occurred due to mycotic aneurysm at 2 weeks; Cytomegalovirus at 4 months; pulmonary infection at 2 years. Twenty-two of 25 patients (88%) are well at last follow-up (up to 8 years).
Despite representing a small percentage of overall OLT activity pediatric OLT were performed with excellent results in a center with sufficient OLT volume and ad hoc surgical, pediatric, and intensive care team expertise.
小儿肝移植（OLT）应仅在大容量小儿肝移植中心还是在成人/小儿混合肝移植中心进行存在争议。我们回顾了一家原本为成人肝移植中心的小儿肝移植结果。
方法/结果：我们的成人肝移植项目始于1989年，目前每年大约移植55例肝脏。小儿肝移植项目于1999年启动。移植前后的随访是多学科的。在研究期间，对25例患者进行了26例肝移植（占所有肝移植的6%；n = 430）。平均年龄为8岁（范围：1个月至18岁）。平均体重为22千克（4至80千克）。适应证为：1例急性肝衰竭（4%）；25例慢性肝衰竭（96%）——10例代谢性疾病、6例胆道闭锁、5例多囊肝/肝纤维化、4例其他疾病以及1例再次移植。9例（35%）接受部分肝移植；5例（19%）接受多脏器移植（肝-肾、肝-肠），12例（46%）接受传统肝移植。对于所有体重轻的儿童，均采用了显微外科手术。免疫抑制包括钙调神经磷酸酶抑制剂（环孢素/他克莫司）、硫唑嘌呤/霉酚酸酯、低剂量类固醇以及14例使用抗白细胞介素-2受体。未出现早期肝动脉血栓形成（HAT）、门静脉血栓形成和原发性无功能。1例（4%）在移植后4年因晚期HAT进行了再次移植。在术后2周、4个月和2年出现了3例胆道并发症（11%）。早期急性排斥反应和慢性排斥反应的发生率分别为7.7%和0%。3例死亡分别发生在术后2周因霉菌性动脉瘤、4个月因巨细胞病毒感染、2年因肺部感染。25例患者中有22例（88%）在最后一次随访时（最长8年）情况良好。
尽管小儿肝移植在总体肝移植活动中占比小，但在一个具备足够肝移植量以及专门的外科、小儿科和重症监护团队专业知识的中心进行时，取得了优异的结果。
