二次肝移植后儿童的结局与首次肝移植后相似：一项跨国登记分析。

Outcomes for children after second liver transplantations are similar to those after first transplantations: a binational registry analysis.

机构信息

Sir Charles Gairdner Hospital, Perth, WA.

The University of Western Australia, Perth, WA.

出版信息

Med J Aust. 2020 Nov;213(10):464-470. doi: 10.5694/mja2.50802. Epub 2020 Oct 4.

DOI:10.5694/mja2.50802

PMID:33015834

Abstract

OBJECTIVE

To assess long term graft and patient survival after donor liver retransplantation in children in Australia and New Zealand during 1986-2017; to determine the factors that influence survival.

DESIGN

Retrospective cohort analysis (registry data).

SETTING, PARTICIPANTS: Australia and New Zealand Liver Transplant Registry data for all liver retransplantations in children (under 18 years of age), 1986-2017, in all four paediatric and six adult liver transplantation centres in the two countries.

MAIN OUTCOME MEASURES

Graft and patient survival at one, 5, 10 and 15 years.

RESULTS

142 liver retransplantations were undertaken in children (59 during 1986-2000, 83 during 2001-2017). Kaplan-Meier survival analysis indicated that survival was significantly greater during 2001-2017 than 1986-2000 (P < 0.001). During 2001-2017, graft survival one year after retransplantation was 84%, at 5 years 75%, at 10 years 70%, and at 15 years 54%; patient survival was 89% at one year, 87% at 5 years, 87% at 10 years, and 71% at 15 years. Median time between transplantations was 0.2 years (IQR, 0.03-1.4 years) during 1986-2000, and 1.8 years (IQR, 0.1-6.8 years) during 2001-2017 (P = 0.002). The proportion of graft failures that involved split grafts was larger during 2001-2017 (35 of 83, 42%) than 1986-2000 (10 of 59, 17%). Graft type, cause of graft failure, and number of transplants did not influence survival following retransplantation.

CONCLUSION

Survival for children following retransplantation is excellent. Graft survival is similar for split and whole grafts. Children on the liver waiting list requiring retransplantation should have the same access to donor grafts as children requiring a first transplant.

摘要

目的

评估 1986 年至 2017 年间澳大利亚和新西兰供肝再次移植后患儿的长期移植物和患者存活率；确定影响存活率的因素。

设计

回顾性队列分析（登记数据）。

地点、参与者：澳大利亚和新西兰肝脏移植登记处的数据包括所有在该国四个儿科和六个成人肝脏移植中心接受的 1986 年至 2017 年间 18 岁以下儿童的肝脏再次移植，共 142 例。

主要观察指标

1 年、5 年、10 年和 15 年的移植物和患者存活率。

结果

142 例儿童进行了肝脏再次移植（1986 年至 2000 年期间 59 例，2001 年至 2017 年期间 83 例）。Kaplan-Meier 生存分析表明，2001 年至 2017 年的生存率明显高于 1986 年至 2000 年（P<0.001）。在 2001 年至 2017 年期间，再次移植后一年的移植物存活率为 84%，五年为 75%，十年为 70%，十五年为 54%；患者一年生存率为 89%，五年生存率为 87%，十年生存率为 87%，十五年生存率为 71%。1986 年至 2000 年期间，两次移植之间的中位时间为 0.2 年（IQR，0.03-1.4 年），2001 年至 2017 年期间为 1.8 年（IQR，0.1-6.8 年）（P=0.002）。2001 年至 2017 年期间，涉及劈裂供肝的移植物失功比例大于 1986 年至 2000 年（83 例中有 35 例，42%）。移植物失功的原因、移植物类型和移植次数均不影响再次移植后的存活率。