General Surgery and Transplantation Unit, Polo Ospedaliero Interaziendale Trapianti (POIT), San Camillo-Forlanini General Hospital, Circ.ne Gianicolense 87, 00152, Rome, Italy.
Updates Surg. 2011 Sep;63(3):191-200. doi: 10.1007/s13304-011-0096-1. Epub 2011 Jul 19.
The aim of this study was to critically analyze the early and long-term results of a newborn liver transplantation (LTx) centre using piggyback technique (PT) without venovenous bypass and portocaval shunt in the era of extended criteria donors (ECDs). Between 2002 and 2010, a total of 229 LTx were performed in 225 patients, with the shortest as possible cold ischemia time (CIT) policy. The charts of the donors and recipients and the intraoperative data were retrospectively reviewed in order to define the feasibility of PT and surgical outcome, and long-term graft and patient survival. PT feasibility rate was 100%, with a median duration of surgery of 390 min (range 210-630) and median unit of packed RBC transfused intraoperatively of 1 U (range 1-10). Median CIT was 400 min (range 130-870), and median AST peak was 403 mmol/L (range 48-16,900). ECDs graft rate was 85%. Over all primary dysfunction and non-function (PNF) rates were 7.4 and 2.2%, respectively and increased with graft steatosis >30% (P < 0.004). Mortality, morbidity, re-operation and re-LTx rates were 4.4, 25, 6.1 and 1.3%, respectively, and median hospital stay was 18 days (range 8-150). On the long term, graft and patient 5-year overall survival were 72 and 74%, respectively, and re-LTx rate was 0.4%. Survival was significantly affected by recipient HCV-Ab seropositive status (67 vs. 85%, P = 0.023). Liver transplantation can be performed with low morbidity and mortality rates, despite ECDs. PT is a safe and effective procedure that, combined with short CIT, entailed prompt early functional recovery of the grafts and positive long-term results.
本研究旨在批判性分析在使用扩展标准供体（ECD）的时代，使用背驮式技术（PT）不进行静脉-静脉旁路和门腔分流的新生儿肝移植（LTx）中心的早期和长期结果。2002 年至 2010 年，共对 225 例患者中的 229 例进行了 LTx，采用尽可能短的冷缺血时间（CIT）策略。回顾供体和受者的图表以及术中数据，以确定 PT 的可行性和手术结果以及长期移植物和患者存活率。PT 的可行性率为 100%，手术时间中位数为 390 分钟（范围 210-630），术中输注的浓缩红细胞单位中位数为 1U（范围 1-10）。中位 CIT 为 400 分钟（范围 130-870），AST 峰值中位数为 403mmol/L（范围 48-16900）。ECD 移植物使用率为 85%。所有原发性功能障碍和无功能（PNF）率分别为 7.4%和 2.2%，且随着移植物脂肪变性>30%而增加（P<0.004）。死亡率、发病率、再次手术和再次 LTx 率分别为 4.4%、25%、6.1%和 1.3%，中位住院时间为 18 天（范围 8-150）。长期来看，移植物和患者 5 年总生存率分别为 72%和 74%，再次 LTx 率为 0.4%。受者 HCV-Ab 阳性状态显著影响生存率（67%比 85%，P=0.023）。尽管使用 ECD，但 LTx 仍可实现低发病率和死亡率。PT 是一种安全有效的方法，与短 CIT 相结合，导致移植物早期功能迅速恢复，并获得积极的长期结果。
