Yamada Naoya, Sanada Yukihiro, Hirata Yuta, Okada Noriki, Ihara Yoshiyuki, Sasanuma Hideki, Urahashi Taizen, Sakuma Yasunaru, Yasuda Yoshikazu, Mizuta Koichi
Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
Pediatr Surg Int. 2016 Apr;32(4):363-8. doi: 10.1007/s00383-016-3859-4. Epub 2016 Jan 19.
We aimed to evaluate patients who had undergone pediatric LDLT with small-for-size graft (SFSG) and identify risk factors of graft failure to establish a preoperative graft selection strategy.
The data was collected retrospectively. SFSG was used in 14LDLTs (5.7%) of 245 LDLTs performed between May 2001 and March 2014. The mean patient age and body weight at LDLT were 12.6 ± 2.0 years and 40.5 ± 9.9 kg, respectively. The graft type was left lobe in six patients, left + caudate lobe in seven patients, and posterior segment in one patient.
The graft survival rates in SFSG and non-SFSG groups were 78.9 and 93.1%, respectively (p = 0.045). In the univariate analysis, bleeding volume during LDLT were an independent risk factors for graft failure (p = 0.011). Graft failure was caused by sepsis in all three patients and occurred at a median of 70 postoperative days 70 (range 14-88 days). Among them, two cases showed high preoperative PELD/MELD score (PELD; 19.4 and MELD; 22, respectively).
Pediatric LDLT using SFSG had poor outcome and prognosis, especially when it accompanies the surgical infectious complications with preoperative high PELD/MELD scores.
我们旨在评估接受小体积供肝（SFSG）的小儿活体肝移植（LDLT）患者，并确定移植失败的危险因素，以制定术前供肝选择策略。
回顾性收集数据。在2001年5月至2014年3月期间进行的245例LDLT中，14例（5.7%）使用了SFSG。LDLT时患者的平均年龄和体重分别为12.6±2.0岁和40.5±9.9kg。供肝类型为左叶6例，左叶+尾状叶7例，右后叶1例。
SFSG组和非SFSG组的移植存活率分别为78.9%和93.1%（p=0.045）。单因素分析显示，LDLT术中出血量是移植失败的独立危险因素（p=0.011）。所有3例移植失败均由败血症引起，中位发生时间为术后70天（范围14-88天）。其中2例术前PELD/MELD评分较高（PELD分别为19.4和MELD为22）。
使用SFSG的小儿LDLT预后较差，尤其是伴有手术感染并发症且术前PELD/MELD评分较高时。
