Uribe M, González G, Alba A, Godoy J, Ferrario M, Hunter B, Iñiguez R, Cavallieri S, Díaz V, Macho L, Ferrón S, Buckel E
Liver Transplant Program Clínica Las Condes, Hospital Luis Calvo Mackenna, Santiago, Chile.
Transplant Proc. 2008 Nov;40(9):3253-5. doi: 10.1016/j.transproceed.2008.03.128. Epub 2008 Jun 30.
Living donor liver transplantation (LDLT) for patients with acute liver failure (ALF) is still controversial. To be considered a feasible alternative, this therapeutic option should offer similar results to transplants performed with cadaveric grafts, without significant risks for donors. The aim of this study was to compare the outcomes of pediatric patients with ALF who were transplanted with either cadaveric or living donor grafts.
Between March 1994 and February 2007, 149 patients under 18 years were transplanted, including 43 (28.8%) with ALF. We reviewed the demography, etiology, surgical technique, complications, and long-term results in this group. Patient actuarial survival was determined by Kaplan-Meier analysis.
The median age of the recipients was 4.8 years (range 1.2 to 18) including 26 boys and 17 girls. Sixteen (37.2%) underwent LDLT. Three patients in the living donor group needed a second graft (18.7%) versus 7 (26%) among the cadaveric group. No mortality or serious morbidity was observed in living donors. Fifteen patients died. Septic and neurologic complications, and primary graft non-function were the most frequent causes of death. All patients died during the first year after liver transplant. Actuarial 1- and 5-year survivals were 65% without a significant difference between the groups.
Considering that patients with ALF have no chance of survival without transplantation and that cadaveric grafts remain a limited resource, especially in our country, these results showed that LDLT was a valid option for these patients, as well as a secure procedure for the donors.
对于急性肝衰竭（ALF）患者，活体供肝肝移植（LDLT）仍存在争议。要被视为一种可行的替代方案，这种治疗选择应能提供与尸体供肝移植相似的效果，且对供体无重大风险。本研究的目的是比较接受尸体或活体供肝移植的小儿ALF患者的结局。
1994年3月至2007年2月期间，149例18岁以下患者接受了移植，其中43例（28.8%）为ALF患者。我们回顾了该组患者的人口统计学、病因、手术技术、并发症及长期结果。通过Kaplan-Meier分析确定患者的精算生存率。
受者的中位年龄为4.8岁（范围1.2至18岁），包括26名男孩和17名女孩。16例（37.2%）接受了LDLT。活体供肝组有3例患者需要二次移植（18.7%），而尸体供肝组为7例（26%）。未观察到活体供体死亡或严重并发症。15例患者死亡。感染性和神经系统并发症以及原发性移植物无功能是最常见的死亡原因。所有患者均在肝移植后的第一年内死亡。1年和5年精算生存率均为65%，两组之间无显著差异。
鉴于ALF患者若不进行移植则无生存机会，且尸体供肝仍然是一种有限的资源，尤其是在我国，这些结果表明LDLT对这些患者是一种有效的选择，对供体也是一种安全的手术。
