Department of Surgery, The University of Hong Kong.
Department of Surgery, The University of Hong Kong.
J Pediatr Surg. 2020 Sep;55(9):1892-1896. doi: 10.1016/j.jpedsurg.2019.10.016. Epub 2019 Nov 9.
The objective of this study was to determine the most optimal timing of liver transplant (LT) for post-Kasai portoenterostomy (KPE) patients based on disease severity scores.
This was a retrospective study and the clinical data of all LT recipients aged <18 years (n = 89) with a history of KPE were analyzed. They were divided into three groups according to their PELD/MELD scores at the time of LT (A: <15; B: 15-25; C: >25). The effects of LT on the clinical outcomes and hospitalization status were analyzed.
There were 33, 34 and 22 patients in group A, B and C, respectively. There was no significant difference in 3-year graft survival rate between the three groups but group C patients had the highest incidence of vascular or biliary complications (p = 0.022). Group C patients had a significantly lower hospital admission frequency (p = 0.036) and shorter hospital stay (p = 0.041) after LT when compared with their pre-LT status and with non-LT patients with similar disease severity scores. On the other hand, the hospitalization frequency and duration were similar in patients with the lowest disease severity score (group A) before, after and without LT.
The benefit of LT was less obvious when the disease severity score is <15. A high complication rate was reported when LT was performed at a score > 25. Donor availability, the patient's general condition and parental wish should be considered during individual assessment.
Clinical research paper.
Level III.
本研究旨在根据疾病严重程度评分确定行Kasai 门静脉肠吻合术（KPE）后肝移植（LT）的最佳时机。
这是一项回顾性研究，分析了所有 LT 受者的临床数据，这些受者年龄<18 岁，有 KPE 病史（n=89）。根据 LT 时的 PELD/MELD 评分将他们分为三组（A：<15；B：15-25；C：>25）。分析 LT 对临床结局和住院状态的影响。
A、B 和 C 组患者分别为 33、34 和 22 例。三组患者 3 年移植物存活率无显著差异，但 C 组患者血管或胆道并发症发生率最高（p=0.022）。与 LT 前相比，与疾病严重程度评分相似但未行 LT 的患者相比，C 组患者 LT 后住院频率（p=0.036）和住院时间（p=0.041）显著降低。另一方面，疾病严重程度评分最低的患者（A 组）在 LT 前后的住院频率和时间相似。
当疾病严重程度评分<15 时，LT 的获益不明显。当评分>25 时，LT 报告的并发症发生率较高。在个体评估时，应考虑供体可用性、患者一般状况和家长意愿。
临床研究论文。
III 级。
