Mizuta K, Sanada Y, Wakiya T, Urahashi T, Umehara M, Egami S, Hishikawa S, Okada N, Kawano Y, Saito T, Hayashida M, Takahashi S, Yoshino H, Shimizu A, Takatsuka Y, Kitamura T, Kita Y, Uno T, Yoshida Y, Hyodo M, Sakuma Y, Fujiwara T, Ushijima K, Sugimoto K, Ohmori M, Ohtomo S, Sakamoto K, Nakata M, Yano T, Yamamoto H, Kobayashi E, Yasuda Y, Kawarasaki H
Liver Transplant Team, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, 329-0498, Japan.
Transplant Proc. 2010 Dec;42(10):4127-31. doi: 10.1016/j.transproceed.2010.11.002.
To describe our experience with 126 consecutive living-donor liver transplantation (LDLT) procedures performed because of biliary atresia and to evaluate the optimal timing of the operation.
Between May 2001 and January 2010,126 patients with biliary atresia underwent 130 LDLT procedures. Mean (SD) patient age was 3.3 (4.2) years, and body weight was 13.8 (10.7) kg. Donors included 64 fathers, 63 mothers, and 3 other individuals. The left lateral segment was the most commonly used graft (75%). Patients were divided into 3 groups according to body weight: group 1, less than 8 kg (n = 40); group 2,8 to 20 kg (n = 63); and group 3, more than 20 kg (n = 23). Medical records were reviewed retrospectively. Follow up was 4.5 (2.7) years.
All group 3 donors underwent left lobectomy, and all group 1 donors underwent left lateral segmentectomy. No donors required a second operation or died. Comparison of the 3 groups demonstrated that recipient Pediatric End-Stage Liver Disease score in group 1 was highest, operative blood loss in group 2 was lowest (78 mL/kg), and operative time in group 3 was longest (1201 minutes). Hepatic artery complications occurred more frequently in group 1 (17.9%), and biliary stenosis (43.5%) and gastrointestinal perforation (8.7%) occurred more frequently in group 3. The overall patient survival rates at 1, 5, and 9 years was 98%, 97%, and 97%, respectively. Five-year patient survival rate in groups 1,2, and 3 were 92.5%, 100%, and 95.7%, respectively. Gastrointestinal perforation (n = 2) was the primary cause of death.
Living-donor liver transplantation is an effective treatment of biliary atresia, with good long-term outcome. It seems that the most suitable time to perform LDLT to treat biliary atresia is when the patient weighs 8 to 20 kg.
描述我们对126例因胆道闭锁而进行的连续活体肝移植（LDLT）手术的经验，并评估手术的最佳时机。
2001年5月至2010年1月期间，126例胆道闭锁患者接受了130例LDLT手术。患者平均（标准差）年龄为3.3（4.2）岁，体重为13.8（10.7）kg。供体包括64位父亲、63位母亲和3位其他个体。左外侧叶是最常用的移植物（75%）。根据体重将患者分为3组：第1组，体重小于8kg（n = 40）；第2组，体重8至20kg（n = 63）；第3组，体重大于20kg（n = 23）。对病历进行回顾性分析。随访时间为4.5（2.7）年。
第3组所有供体均接受左半肝切除术，第1组所有供体均接受左外侧叶切除术。没有供体需要二次手术或死亡。3组比较显示，第1组受者的儿童终末期肝病评分最高，第2组术中失血量最低（78mL/kg），第3组手术时间最长（1201分钟）。第1组肝动脉并发症发生率更高（17.9%），第3组胆道狭窄（43.5%）和胃肠道穿孔（8.7%）发生率更高。患者1年、5年和9年的总体生存率分别为98%、97%和97%。第1组、第2组和第3组的5年患者生存率分别为92.5%、100%和95.7%。胃肠道穿孔（n = 2）是主要死亡原因。
活体肝移植是治疗胆道闭锁的有效方法，长期效果良好。似乎治疗胆道闭锁进行LDLT的最合适时机是患者体重8至20kg时。
