Loveland Jerome, Britz Russell, Joseph Craig, Sparaco Anna, Zuckerman Michele, Langnas Alan, Schleicher Gunter, Strobele Bernd, Moshesh Porai, Botha Jean
Transplant Division, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2014 Oct 24;104(11):799-802. doi: 10.7196/samj.8627.
A paediatric liver transplant programme was started at the Wits Donald Gordon Medical Centre, Johannesburg, South Africa (SA), in November 2005. We reported on the first 29 patients in 2012. Since then we have performed a further 30 transplants in 28 patients, having met the major challenge of donor shortage by introducing a living related donor programme and increasing the use of split liver grafts.
To review the Wits Donald Gordon Medical Centre paediatric liver transplant programme to date. We describe how the programme has evolved and specifically compare the outcomes of the first cohort with the most recent 28 patients.
Case notes of all paediatric liver transplants performed between 14 November 2005 and 30 June 2014 were retrospectively reviewed. Data were analysed for age and weight at transplantation, indication and type of graft. Morbidity and mortality were documented, specifically biliary and vascular complications. Comparison was made between Era 1 (November 2005 - October 2012) and Era 2 (November 2012 - June 2014).
A total of 59 transplants were performed in 57 patients. Age at transplantation ranged from 9 months to 213 months (mean 82.39 months) and weight ranged from 5 kg to 62 kg (mean 21 kg). A total of 23 whole livers, 10 reduced-size grafts, 14 split liver grafts and 12 living donor liver transplants (LDLTs) were performed. Eight patients were referred with fulminant hepatic failure (FHF), all in Era 2. Of these, three patients were successfully transplanted. Of the 57 patients, 45 are alive and well with actuarial 1-year patient and graft survival of 85% and 84% and 5-year patient and graft survival of 78% and 74%, respectively. Sixteen (25.42%) biliary complications occurred in 15 of our 59 transplants. Seven patients developed significant vascular complications. Comparing Era 1 with Era 2, mean age at transplant decreased from 100.86 months to 64.73 months, mean weight from 25.2 kg to 16.9 kg, and type of graft utilised changed with a trend away from the use of whole livers and reduced-sized grafts to split livers and segment 2,3 LDLT grafts.
Initially limited by a shortage of donor organs, we aggressively explored optimal utilisation, splitting liver grafts from deceased donors as often as possible and establishing an LDLT programme. This increased access to donor livers allowed us to include patients with FHF and to perform retransplantation in recipients with early graft failure. It remains to offer liver transplantation to the entire paediatric community in SA, in conjunction with the only other established paediatric liver transplant unit, at Red Cross War Memorial Children's Hospital in Cape Town.
2005年11月，南非约翰内斯堡的威特斯唐纳德·戈登医疗中心启动了小儿肝移植项目。2012年我们报道了首批29例患者。从那时起，我们又在28例患者中进行了30例移植手术，通过引入亲属活体供肝项目和增加劈离式肝移植的使用，应对了供体短缺这一重大挑战。
回顾威特斯唐纳德·戈登医疗中心迄今为止的小儿肝移植项目。我们描述该项目的发展历程，并特别比较首批队列与最近28例患者的结局。
对2005年11月14日至2014年6月30日期间进行的所有小儿肝移植病例记录进行回顾性分析。分析移植时的年龄和体重、移植指征及移植物类型等数据。记录发病率和死亡率，特别是胆道和血管并发症。对第1阶段（2005年11月 - 2012年10月）和第2阶段（2012年11月 - 2014年6月）进行比较。
共对57例患者进行了59例移植手术。移植时年龄从9个月至213个月（平均82.39个月），体重从5千克至62千克（平均21千克）。共进行了23例全肝移植、10例减体积肝移植、14例劈离式肝移植和12例活体供肝肝移植（LDLT）。8例患者因暴发性肝衰竭（FHF）转诊，均在第2阶段。其中3例患者成功接受移植。57例患者中，45例存活且情况良好，1年患者和移植物存活率分别为精算值85%和84%，5年患者和移植物存活率分别为78%和74%。59例移植手术中有15例（25.42%）发生了16例胆道并发症。7例患者出现了严重的血管并发症。比较第1阶段和第2阶段，移植时的平均年龄从100.86个月降至64.73个月，平均体重从25.2千克降至16.9千克，所使用的移植物类型发生了变化，趋势是从使用全肝和减体积肝移植转向劈离式肝移植和第2、3段LDLT移植物。
最初受供体器官短缺限制，我们积极探索最佳利用方式，尽可能多地劈离尸体供肝并建立LDLT项目。增加供肝的可及性使我们能够纳入FHF患者，并对早期移植物功能衰竭的受者进行再次移植。仍有待与开普敦红十字战争纪念儿童医院唯一另一家已建立的小儿肝移植单位合作，为南非整个小儿群体提供肝移植服务。
