Kanamori Keita, Kubota Masaya, Sakamoto Seisuke, Ishiguro Akira, Kasahara Mureo
Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.
Division of Neurology, National Center for Child Health and Development, Tokyo, Japan.
Brain Dev. 2021 May;43(5):637-643. doi: 10.1016/j.braindev.2021.01.002. Epub 2021 Feb 2.
Liver transplantation (LT) has been used as a definitive management for children with end-stage liver disease or acute liver failure. Living-donor LT (LDLT) has been a common type of LT performed in Asian countries, including Japan, where deceased donors are rarely available. However, the neurological complications (NCs) associated with LDLT remain unknown. The purpose of this study was to clarify the characteristics of NCs in children after LDLT.
This study is a retrospective observational study carried out at a tertiary children's hospital in Japan. We studied children who had undergone LDLT between January 2001 and January 2020.
We examined 602 cases of LT, of which 559 were LDLT cases (92.9%). NCs after LT were present in 21 cases (3.8%). The most common neurological symptoms were seizure (n = 17), whereas disturbance of consciousness without seizure was observed in four cases. The frequency of NCs for each of the indications was 12.2% for fulminant hepatic failure, 6.5% for metabolic liver disease, and 0.7% for cholestatic liver disease.
We report the characteristics of NCs after LDLT in children. The frequency of NCs after LT was high in cases of fulminant hepatic failure and metabolic diseases, who might have had neurological symptoms or impaired consciousness before LT.
肝移植（LT）已被用作终末期肝病或急性肝衰竭儿童的确定性治疗方法。活体供肝肝移植（LDLT）一直是包括日本在内的亚洲国家常见的肝移植类型，在这些国家，脑死亡供体很少。然而，与LDLT相关的神经并发症（NCs）仍不清楚。本研究的目的是阐明LDLT术后儿童NCs的特征。
本研究是在日本一家三级儿童医院进行的一项回顾性观察研究。我们研究了2001年1月至2020年1月期间接受LDLT的儿童。
我们检查了602例肝移植病例，其中559例为LDLT病例（92.9%）。肝移植术后出现NCs的有21例（3.8%）。最常见的神经症状是癫痫发作（n = 17），而4例出现无癫痫发作的意识障碍。每种适应证的NCs发生率分别为：暴发性肝衰竭12.2%，代谢性肝病6.5%，胆汁淤积性肝病0.7%。
我们报告了儿童LDLT术后NCs的特征。暴发性肝衰竭和代谢性疾病患儿肝移植术后NCs的发生率较高，这些患儿在肝移植术前可能已有神经症状或意识障碍。
