Departments of Transplant Surgery, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan.
Pharmacology, Jichi Medical University Hospital, Jichi Medical University, Shimotsuke City, Japan.
Liver Transpl. 2019 Jul;25(7):1066-1073. doi: 10.1002/lt.25446. Epub 2019 May 27.
Early relaparotomy of adult recipients after living donor liver transplantation (LDLT) is significantly associated with poor prognosis. However, there are few reports focusing on pediatric recipients after LDLT. The aim of this study is to clarify the causes and outcomes of early relaparotomy after pediatric LDLT. A total of 265 pediatric recipients (272 LDLTs) transplanted from May 2001 to October 2015 were retrospectively analyzed. Early relaparotomy was defined as surgical intervention performed within 3 months after LDLT. Early relaparotomy was performed 49 times for 33 recipients (12.5%). The recipient and graft survival rates in the early relaparotomy group were significantly lower than those in the nonearly relaparotomy group, respectively (75.0% and 63.6% versus 96.6% and 95.8%; both P < 0.001). Left lateral segment grafts were used significantly more frequently in the nonrelaparotomy group (P = 0.01). According to the multivariate analysis, the preoperative Pediatric End-Stage Liver Disease (PELD)/Model for End-Stage Liver Disease (MELD) score of the early relaparotomy group was significantly higher than that of the nonearly relaparotomy group (13.7 versus 6.3; P = 0.04). According to the receiver operating characteristic curve, the preoperative PELD/MELD score cutoff point was 17.2. Early relaparotomy due to infectious causes led to significantly poorer graft survival than that due to noninfectious causes (P = 0.04). In conclusion, the recipient and graft survival rates of the early relaparotomy group were significantly lower than those of the nonearly relaparotomy group. A high preoperative PELD/MELD score was a risk factor for early relaparotomy. In particular, early relaparotomy due to infection showed a poor prognosis.
在活体肝移植（LDLT）后，成人受者早期再次剖腹手术与预后不良显著相关。然而，针对 LDLT 后儿科受者的相关报道较少。本研究旨在阐明 LDLT 后儿科受者早期再次剖腹手术的原因和结局。回顾性分析了 2001 年 5 月至 2015 年 10 月期间接受 LDLT 的 265 例儿科受者（272 例 LDLT）。早期再次剖腹手术定义为 LDLT 后 3 个月内进行的手术干预。33 例（12.5%）受者进行了 49 次早期再次剖腹手术。早期再次剖腹手术组的受者和移植物存活率明显低于无早期再次剖腹手术组（分别为 75.0%和 63.6%比 96.6%和 95.8%；均 P<0.001）。无早期再次剖腹手术组更频繁地使用左外叶移植物（P=0.01）。多因素分析显示，早期再次剖腹手术组的术前小儿终末期肝病评分（PELD）/终末期肝病模型评分（MELD）显著高于无早期再次剖腹手术组（13.7 比 6.3；P=0.04）。根据受试者工作特征曲线，术前 PELD/MELD 评分的截断点为 17.2。由感染引起的早期再次剖腹手术导致移植物存活率明显低于非感染性原因（P=0.04）。总之，早期再次剖腹手术组的受者和移植物存活率明显低于无早期再次剖腹手术组。术前高 PELD/MELD 评分是早期再次剖腹手术的危险因素。特别是，由感染引起的早期再次剖腹手术预后较差。
