Saint Louis University, Saint Louis, Missouri, USA.
Emmes Corporation, Rockville, Maryland, USA.
Am J Transplant. 2021 Mar;21(3):1113-1127. doi: 10.1111/ajt.16236. Epub 2020 Sep 5.
Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre-, intra-, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0-<3, 3-<6, 6-<12 months, and 1-<3 years (Groups A, B, C, D respectively) and by weight categories: <5, 5-10, >10 kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5 kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P < .001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P < .001), and shortest wait times (P < .001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1-3.9] and 16.7 [6.8-29.7] mg/dL) and those <5 kg (2.6 [1.8-3.4] and 13.5 [3.0-28.4] mg/dL). A pediatric end -stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5 kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes.
儿童肝移植（LT）的应用日益增多。我们假设对术前、术中和术后事件进行客观分析，有助于了解成功结局的影响因素，并指导移植决策过程。我们在 SPLIT 登记处查询了 2011 年至 2018 年期间进行的儿童肝移植。将年龄组（0-<3 个月、3-<6 个月、6-<12 个月和 1-<3 岁，分别为 A、B、C、D 组）和体重组（<5kg、5-10kg、>10kg）的结果进行比较；共分析了 1033 例患者。A 组胆汁淤积性疾病和暴发性肝功能衰竭发生率最高，<5kg 体重组和 C 组（72.8%）胆道闭锁发生率最高。A 组生命支持依赖率显著升高（34.6%；P<.001），作为 UNOS 1a/1b 状态的比例较高（70.4%；P<.001），等待时间最短（P<.001）。A 组国际标准化比值和胆红素中位数（四分位间距）最高（3.0[2.1-3.9]和 16.7[6.8-29.7]mg/dL），<5kg 体重组的比值也较高（2.6[1.8-3.4]和 13.5[3.0-28.4]mg/dL）。A 组患儿的小儿终末期肝病评分≥40 分、术后住院时间、排斥反应和非吻合口胆管狭窄的发生率较高，93.1%的患儿生存率最低。0-<3 个月的婴儿和<5kg 的婴儿需要更密集的护理，生存率更低，并发症发生率更高。重要的是，在达到 1a/1b 状态之前进行潜在的 LT 并进行积极的术后管理可能会对他们的结局产生积极影响。
