Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
World J Gastroenterol. 2020 Mar 28;26(12):1352-1364. doi: 10.3748/wjg.v26.i12.1352.
Pediatric living donor liver transplantation (LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare.
To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT.
We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital.
The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%, and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period (74.47% 90.74%; hazard ratio: 2.92; 95% confidence interval (CI): 2.16-14.14; = 0.0004). Median duration of mechanical ventilation in the intensive care unit (ICU) was 18 h [interquartile range (IQR), 15.25-20.25], median ICU length of stay was 6 d (IQR: 4.80-9.00), and median postoperative length of stay was 24 d (IQR: 18.00-34.00). Forty-seven (8.60%) of 544 patients did not receive red blood cell transfusion during the operation.
Pediatric end-stage liver disease (PELD) score, anesthesia duration, operation duration, intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score, operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.
儿科活体肝移植（LDLT）已成为终末期肝病患者的金标准。随着器官保存、免疫抑制、手术和麻醉技术的改进，全球范围内 LDLT 后患者的生存率和长期预后均有显著改善。然而，中国儿科 LDLT 的麻醉管理和术后生存率数据较为罕见。
回顾上海儿科 LDLT 的现状，并探讨与儿科 LDLT 麻醉管理和生存率相关的因素。
我们通过回顾 2006 年 10 月 21 日首例手术至 2016 年 8 月 10 日在仁济医院和华山医院接受儿科 LDLT 的 544 例患者的病历，对上海儿科 LDLT 的现状进行回顾性观察研究。
30d、90d、1 年和 2 年的生存率分别为 95.22%、93.38%、91.36%和 89.34%。2011 年 1 月 1 日以后的 2 年患者生存率与前一阶段相比显著提高（74.47% 90.74%；风险比：2.92；95%置信区间（CI）：2.16-14.14； = 0.0004）。重症监护病房（ICU）机械通气中位时间为 18 h [四分位距（IQR）：15.25-20.25]，ICU 中位住院时间为 6 d（IQR：4.80-9.00），术后中位住院时间为 24 d（IQR：18.00-34.00）。544 例患者中，47 例（8.60%）术中未输血。
PELD 评分、麻醉时间、手术时间、术中出血量和 ICU 住院时间是住院患者生存的独立预测因素。PELD 评分、手术时间和 ICU 住院时间是 1 年和 3 年患者生存的独立预测因素。
Zotero 插件