Acuña C, Zuleta R, Dalmazzo R, Valverde C, Uribe M, Alba A, Buckel E, Hunter B, González G, Godoy J, Ferrario M, Cavallieri S, Campos M, Pizarro F, Wash A, Ferrón S, Díaz V, Macho L, Herzog C, Calabrán L, Flores L, Soto P, Heine C, Rebolledo R, Auad H
Hospital Luis Calvo Mackenna, Santiago, Chile.
Transplant Proc. 2013;45(10):3724-5. doi: 10.1016/j.transproceed.2013.08.090.
In 1994 our group began its experience with pediatric liver transplantation. The experience gained during this period is the largest in the country, positioning the Hospital Luis Calvo Mackenna and Clinica Las Condes as major referral centers in the public and private sectors. The aim of this study was to report our experience of our pediatric liver transplantation program during this period.
The liver transplantation database of Hospital Luis Calvo Mackenna and Clinica Las Condes between January 1994 and July 2011 was reviewed recording age, gender, indications for transplantation, surgical technique, complications, and survival. Survival rates were calculated using Kaplan-Meier analysis.
During the period described 230 transplantations were performed in 189 pediatric patients. Fifty-five percent were male patients. The average age was 5 years. The main causes of transplantation were biliary atresia (50%), fulminant hepatic failure (25%), and other cholestatic diseases by 10%. Vascular and biliary complications were the leading cause of graft loss and retransplantation. The overall rate of retransplantation at 5 years was 20%. The technique of living donor was used in 28% of the cases. The 1-year patient actuarial survival rate was 80%, 73% at 5 years, and 68% at 10 years. In the last 3 years the survival rate at 1 year exceeds 90%.
Our program includes more than 90% of the national liver experience. The incorporation of living donor is a milestone that has enabled us to save many patients who previously died while waiting for an organ. Its use in cases of full acute liver failure has allowed us to dramatically reduce mortality on the waiting list. Our results in the last 3 years reflect the experience that results in a significant decrease in mortality, comparing favorably to other series published in the international literature.
1994年，我们团队开始开展小儿肝移植工作。在此期间积累的经验是国内最丰富的，使路易斯·卡尔沃·麦肯纳医院和拉斯孔德斯诊所成为公共和私营部门的主要转诊中心。本研究的目的是报告我们在此期间小儿肝移植项目的经验。
回顾了路易斯·卡尔沃·麦肯纳医院和拉斯孔德斯诊所1994年1月至2011年7月期间的肝移植数据库，记录年龄、性别、移植指征、手术技术、并发症和生存率。采用Kaplan-Meier分析计算生存率。
在所述期间，对189例小儿患者进行了230例移植手术。55%为男性患者。平均年龄为5岁。移植的主要原因是胆道闭锁（50%）、暴发性肝衰竭（25%）和其他胆汁淤积性疾病（10%）。血管和胆道并发症是移植物丢失和再次移植的主要原因。5年时再次移植的总体发生率为20%。28%的病例采用了活体供体技术。患者1年实际生存率为80%，5年时为73%，10年时为68%。在过去3年中，1年生存率超过90%。
我们的项目涵盖了全国90%以上的肝移植经验。活体供体的纳入是一个里程碑，使我们能够挽救许多以前在等待器官时死亡的患者。在急性肝衰竭完全病例中使用活体供体使我们能够显著降低等待名单上的死亡率。我们过去3年的结果反映了经验，即死亡率显著下降，与国际文献中发表的其他系列相比具有优势。
