Liver Transplantation, Institute of Liver Studies, King's College Hospital, London, United Kingdom.
Liver Transpl. 2019 Oct;25(10):1561-1570. doi: 10.1002/lt.25619.
Liver transplantation (LT) for small infants remains challenging because of the demands related to graft selection, surgical technique, and perioperative management. The aim of this study was to evaluate the short-term and longterm outcomes of LT regarding vascular/biliary complications, renal function, growth, and patient/graft survival in infants ≤3 months compared with those of an age between >3 and 6 months at a single transplant center. A total of 64 infants ≤6 months underwent LT and were divided into 2 groups according to age at LT: those of age ≤3 months (range, 6-118 days; XS group, n = 37) and those of age >3 to ≤6 months (range, 124-179 days; S group, n = 27) between 1989 and 2014. Acute liver failure was the main indication for LT in the XS group (n = 31, 84%) versus S (n = 7, 26%). The overall incidence of hepatic artery thrombosis and portal vein thrombosis/stricture were 5.4% and 10.8% in the XS group and 7.4% and 11.1% in the S group, respectively (not significant). The overall incidence of biliary stricture and leakage were 5.4% and 2.7% in the XS group and 3.7% and 3.7% in the S group, respectively (not significant). There was no significant difference between the 2 groups in terms of renal function. No significant difference was found between the 2 groups for each year after LT in terms of height and weight z score. The 1-, 5-, and 10-year patient survival rates were 70.3%, 70.3%, and 70.3% in the XS group compared with 92.6%, 88.9%, and 88.9% in the S group, respectively (not significant). In conclusion, LT for smaller infants has acceptable outcomes despite the challenges of surgical technique, including vascular reconstruction and graft preparation, and perioperative management.
肝移植（LT）在小婴儿中仍然具有挑战性，因为在移植物选择、手术技术和围手术期管理方面都有较高的要求。本研究旨在评估在单一移植中心，与年龄在 3 至 6 个月之间的婴儿相比，LT 后血管/胆道并发症、肾功能、生长和患者/移植物存活率的短期和长期结果。共有 64 名≤6 个月的婴儿接受了 LT，并根据 LT 时的年龄分为 2 组：年龄≤3 个月（范围：6-118 天；XS 组，n=37）和年龄>3 至≤6 个月（范围：124-179 天；S 组，n=27），1989 年至 2014 年期间。急性肝衰竭是 XS 组（n=31，84%）与 S 组（n=7，26%）LT 的主要适应证。XS 组肝动脉血栓形成和门静脉血栓形成/狭窄的总发生率分别为 5.4%和 10.8%，S 组分别为 7.4%和 11.1%（无显著差异）。XS 组胆道狭窄和漏的总发生率分别为 5.4%和 2.7%，S 组分别为 3.7%和 3.7%（无显著差异）。两组肾功能无显著差异。LT 后每年，两组在身高和体重 z 评分方面无显著差异。XS 组的 1、5 和 10 年患者存活率分别为 70.3%、70.3%和 70.3%，S 组分别为 92.6%、88.9%和 88.9%（无显著差异）。总之，尽管存在手术技术、血管重建和移植物准备以及围手术期管理方面的挑战，但对较小婴儿进行 LT 具有可接受的结果。
