Polak Wojciech G, Peeters Paul M J G, Miyamoto Shungo, Sieders Egbert, de Jong Koert P, Porte Robert J, Bijleveld Charles M A, Hendriks Herman G, Tenvergert Elisabeth M, Slooff Maarten J H
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Clin Transplant. 2008 Mar-Apr;22(2):171-9. doi: 10.1111/j.1399-0012.2007.00762.x.
Between November 1982 and March 2006, 67 children with body weight < or =10 kg had a primary liver transplantation from deceased donors in our unit. The aim of this study was to analyze the outcome in terms of patient and graft survival and to search for factors affecting this outcome. Overall, one-, three-, five-, and 10-yr primary patient and graft survival rates were 73%, 71%, 66%, 63% and 59%, 56%, 53%, 48%, respectively. Twenty-four of 67 (36%) children died and in the remaining 22 (33%), the first grafts failed and they were retransplanted. Cox regression analysis revealed that a need for retransplantation and urgent transplantation were important predictors for patient survival (p = 0.04 and p = 0.001, respectively). To assess whether the need for retransplantation can be influenced, all study variables were compared between surviving grafts and failed grafts. Cox regression analysis showed that only donor/recipient (D/R) weight ratio proved to be independent predictor for graft survival (p = 0.004). After comparison of graft survival with the long rank test according to different D/R weight ratios (3.0-7.0), the cut-off point for significantly different graft survival approached 4.0. The one-, three-, five-, and 10-yr graft survival for technical variant grafts with a D/R weight ratio <4.0 was 85%, 68%, 68%, and 68% compared with a D/R weight ratio >4.0 was 44%, 38%, 38%, and 30%, respectively (p = 0.02). In summary, patient survival in children with body weight < or =10 kg is determined by urgent transplantation and the need for retransplantation. Graft loss and retransplantation in small children can be prevented by adequate size matching of donor and recipient whereby a D/R weight ratio <4.0 seems to offer the favorable outcome.
1982年11月至2006年3月期间，我院67例体重≤10 kg的儿童接受了来自脑死亡供者的原位肝移植。本研究旨在分析患者及移植物的生存结局，并探寻影响该结局的因素。总体而言，1年、3年、5年及10年的原发性患者及移植物生存率分别为73%、71%、66%、63%及59%、56%、53%、48%。67例患儿中有24例（36%）死亡，其余22例（33%）首次移植失败后接受了再次移植。Cox回归分析显示，再次移植需求及紧急移植是患者生存的重要预测因素（p值分别为0.04和0.001）。为评估再次移植需求是否可被影响，对存活移植物和失败移植物的所有研究变量进行了比较。Cox回归分析表明，仅供体/受体（D/R）体重比被证明是移植物存活的独立预测因素（p = 0.004）。根据不同的D/R体重比（3.0 - 7.0）进行长秩检验比较移植物存活情况后，移植物存活存在显著差异的临界值接近4.0。D/R体重比<4.0的技术变异移植物的1年、3年、5年及10年移植物生存率分别为85%、68%、68%及68%，而D/R体重比>4.0的移植物生存率分别为44%、38%、38%及30%（p = 0.02）。总之，体重≤10 kg儿童的患者生存取决于紧急移植及再次移植需求。通过供体与受体的合适大小匹配可预防小儿移植物丢失及再次移植，D/R体重比<4.0似乎能带来更好的结局。
