Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
J Pediatr. 2018 May;196:148-153.e2. doi: 10.1016/j.jpeds.2017.11.015. Epub 2018 Jan 4.
To evaluate changes in patient and graft survival for pediatric liver transplant recipients since 2002, and to determine if these outcomes vary by graft type (whole liver transplant, split liver transplant [SLT], and living donor liver transplant [LDLT]).
We evaluated patient and graft survival among pediatric liver-only transplant recipients the PELD/MELD system was implemented using the Scientific Registry of Transplant Recipients.
From 2002-2009 to 2010-2015, survival for SLT at 30 days improved (94% vs 98%; P < .001), and at 1 year improved for SLT (89% to 95%; P <.001) and LDLT (93% to 98%; P = .002). There was no change in survival for whole liver transplant at either 30 days (98% in both; P = .7) or 1 year (94% vs 95%; P = .2). The risk of early death with SLT was 2.14-fold higher in 2002-2009 (adjusted hazard ratio [aHR] vs whole liver transplant, 2.14), but this risk disappeared in 2010-2015 (aHR, 1.13), representing a significant improvement (P = .04). Risk of late death after SLT was similar in both time periods (aHR 2002-2009, 1.14; aHR 2010-2015, 0.88). LDLT had similar risk of early death (aHR 2002-2009, 1.03; aHR 2010-2015, 0.74) and late death (aHR 2002-2009, 0.83; aHR 2010-2015, 0.44). Graft loss was similar for SLT (aHR, 1.09) and was actually lower for LDLT (aHR, 0.71).
In recent years, outcomes after the use of technical variant grafts are comparable with whole grafts, and may be superior for LDLT. Greater use of technical variant grafts might provide an opportunity to increase organ supply without compromising post-transplant outcomes.
评估自 2002 年以来小儿肝移植受者的患者和移植物存活率的变化，并确定这些结果是否因移植物类型（全肝移植、劈裂肝移植[SLT]和活体供肝移植[LDLT]）而异。
我们使用移植受者科学注册处评估了 PELD/MELD 系统实施后小儿肝移植受者的患者和移植物存活率。
2002-2009 年至 2010-2015 年，SLT 的 30 天存活率提高（94%对 98%；P<.001），1 年存活率提高（SLT 89%对 95%；P<.001）和 LDLT（93%对 98%；P=.002）。全肝移植的 30 天存活率（两者均为 98%；P=.7）或 1 年存活率（94%对 95%；P=.2）均无变化。2002-2009 年，SLT 的早期死亡风险高 2.14 倍（调整后的危险比[HR]与全肝移植相比，2.14），但 2010-2015 年该风险消失（HR，1.13），这表明情况明显改善（P=.04）。SLT 后晚期死亡的风险在两个时期相似（2002-2009 年的 HR，1.14；2010-2015 年的 HR，0.88）。LDLT 的早期死亡风险（2002-2009 年的 HR，1.03；2010-2015 年的 HR，0.74）和晚期死亡风险（2002-2009 年的 HR，0.83；2010-2015 年的 HR，0.44）相似。SLT 的移植物丢失率相似（HR，1.09），LDLT 的移植物丢失率实际上较低（HR，0.71）。
近年来，技术变异移植物的使用后结果与全移植物相当，并且 LDLT 可能更优。更多地使用技术变异移植物可能提供增加器官供应的机会，而不会影响移植后的结果。
