Department of Transplant Surgery, Jichi Medical University, Shimotsuke, Japan.
Department of Pharmacy, Jichi Medical University Hospital, Shimotsuke, Japan.
Transpl Int. 2018 Nov;31(11):1216-1222. doi: 10.1111/tri.13285. Epub 2018 Jun 20.
There are few long-term outcome reports for interventional radiology (IVR) treatments for vascular and biliary complications following pediatric living donor liver transplantation (LDLT). Herein, we presented our institution's experience and investigated the efficacy and issues of long-term outcome with IVR treatments. Between May 2001 and September 2016, 279 pediatric LDLTs were performed. The median age at LDLT was 1.4 years old, and the median observation period was 8.2 years. All the biliary reconstructions at LDLT were hepaticojejunostomy. The IVR treatments were selected as endovascular, radiological, or endoscopic interventions. Post-transplant hepatic vein, portal vein, hepatic artery, and biliary complications were present in 7.9%, 14.0%, 5.4%, and 18.3%, respectively. IVR treatment was the first treatment option in 81.8%, 94.9%, 46.7%, and 94.1%, respectively. The recurrence and cure rates following IVR treatment were 42.1%, 21.1%, 44.4%, and 34.0% and 84.2%, 97.4%, 100%, and 88.0%, respectively. The graft survival rates in patients with and without post-transplant vascular and biliary complications were 94.4% and 90.6%, respectively (P = 0.522). The IVR treatments for vascular and biliary complications following pediatric LDLT are the first choice option. Although the recurrence following IVR treatment is a major problem and it is necessary to carefully perform long-term follow-up, IVR treatments have good treatment outcomes.
对于儿科活体肝移植（LDLT）后血管和胆道并发症的介入放射学（IVR）治疗，鲜有长期结局报道。在此，我们介绍了本机构的经验，并研究了 IVR 治疗的长期结局的疗效和问题。2001 年 5 月至 2016 年 9 月，我们共进行了 279 例儿科 LDLT。LDLT 的中位年龄为 1.4 岁，中位观察期为 8.2 年。所有 LDLT 的胆道重建均采用胆肠吻合术。IVR 治疗的选择包括血管内、放射学或内镜介入。移植后肝静脉、门静脉、肝动脉和胆道并发症的发生率分别为 7.9%、14.0%、5.4%和 18.3%。IVR 治疗分别作为首选治疗的比例为 81.8%、94.9%、46.7%和 94.1%。IVR 治疗后的复发率和治愈率分别为 42.1%、21.1%、44.4%和 34.0%和 84.2%、97.4%、100%和 88.0%。有和无移植后血管和胆道并发症的患者的移植物存活率分别为 94.4%和 90.6%（P=0.522）。对于儿科 LDLT 后血管和胆道并发症的 IVR 治疗是首选治疗方法。尽管 IVR 治疗后的复发是一个主要问题，需要仔细进行长期随访，但 IVR 治疗有良好的治疗效果。
