Neto Joao Seda, Feier Flávia H, Bierrenbach Ana Luiza, Toscano Cristiana M, Fonseca Eduardo A, Pugliese Renata, Candido Helry L, Benavides Marcel R, Porta Gilda, Chapchap Paulo
Hepatology and Liver Transplantation, Sao Paulo, Sao Paulo, Brazil.
Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil.
Liver Transpl. 2015 Jul;21(7):922-7. doi: 10.1002/lt.24132.
Biliary atresia (BA) is the main diagnosis leading to liver transplantation (LT) in children. When diagnosed early in life, a Kasai portoenterostomy (Kasai-PE) can prevent or postpone LT. Instances of previous operations can result in difficulties during the LT. We hypothesized that a previous Kasai-PE could affect LT outcomes. A retrospective cohort study of 347 BA patients submitted to LT between 1995 and 2013 at Hospital Sírio-Libanês and A. C. Camargo Cancer Center was conducted. Patients were divided into those with a previous Kasai portoenterostomy early failure (K-EF), Kasai portoenterostomy late failure (K-LF), and those with no Kasai portoenterostomy (No-K). Primary outcomes were patient and graft survival. A total of 94 (27.1%) patients had a K-EF, 115 (33.1%) had a K-LF, and 138 (39.8%) had No-K before LT. Children in the K-LF group were older and had lower Pediatric End-Stage Liver Disease (PELD) scores. Patients in both K-EF and K-LF groups had more post-LT biliary complications. After Cox-multivariate analysis adjusting for confounding factors to determine the influence of Kasai-PE on patient and graft survival, the K-LF group had an 84% less probability of dying and a 55% less chance to undergo retransplantation. The K-LF group had a protective effect on posttransplant patient and graft survival. When properly performed, the Kasai procedure can postpone LT and positively affect outcomes. Having a K-EF and having not performed a Kasai-PE had the same effect in patient and graft survival; however, a previous Kasai-PE can increase post-LT complications as biliary complications and bowel perforations.
胆道闭锁（BA）是导致儿童肝移植（LT）的主要诊断原因。若在生命早期得到诊断，Kasai肝门肠吻合术（Kasai-PE）可预防或推迟肝移植。既往手术史可能会给肝移植带来困难。我们推测既往Kasai-PE可能会影响肝移植结局。对1995年至2013年间在黎巴嫩叙利亚医院和A.C.卡马戈癌症中心接受肝移植的347例BA患者进行了一项回顾性队列研究。患者被分为既往Kasai肝门肠吻合术早期失败（K-EF）组、Kasai肝门肠吻合术晚期失败（K-LF）组和未行Kasai肝门肠吻合术（No-K）组。主要结局指标为患者和移植物生存率。共有94例（27.1%）患者为K-EF，115例（33.1%）为K-LF，138例（39.8%）在肝移植前未行Kasai-PE。K-LF组患儿年龄较大，儿童终末期肝病（PELD）评分较低。K-EF组和K-LF组患者肝移植后胆道并发症均较多。在对混杂因素进行Cox多变量分析以确定Kasai-PE对患者和移植物生存的影响后，K-LF组死亡概率降低84%，再次移植几率降低55%。K-LF组对移植后患者和移植物生存具有保护作用。当操作适当时，Kasai手术可推迟肝移植并对结局产生积极影响。K-EF组和未行Kasai-PE组在患者和移植物生存方面效果相同；然而，既往Kasai-PE可能会增加肝移植后如胆道并发症和肠穿孔等并发症的发生。
