Stefanowicz Marek, Kowalewski Grzegorz, Szymczak Marek, Patkowski Waldemar, Zieniewicz Krzysztof, Grzelak Ireneusz, Kowalski Adam, Ismail Hor, Kamińska Diana, Kaliciński Piotr
Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute Warsaw, 04-730 Warszawa, Poland.
Department of General Surgery, Transplantation and Liver Surgery, Warsaw Medical University, 02-091 Warsaw, Poland.
Children (Basel). 2021 Jul 6;8(7):579. doi: 10.3390/children8070579.
We aimed to assess the impact of the graft-recipient weight ratio (GRWR) on early post-transplant complications and patient survival rates in children after living donor liver transplantation (LDLT). We retrospectively analyzed 321 patients who underwent LDLT from 2004 to 2019. The recipients were categorized into four groups: 37 patients had a GRWR ≤ 1.5% (Group A), 196 patients had a GRWR > 1.5% and ≤3.5% (Group B), 73 patients had a GRWR > 3.5% and <5% (Group C) and 15 patients had a GRWR ≥ 5% (Group D). Incidence of early surgical complications including vascular complications, biliary complications, postoperative bleedings, gastrointestinal perforations and graft loss were comparable among groups with a different GRWR. Delayed abdominal wound closure was more common in patients with a GRWR > 3.5%. Recipients with a GRWR < 5% had a significantly better prognosis concerning patients and graft survival. Using grafts with a GRWR < 5% allows us to expand the donor pool and decrease the risk of mortality while on the waiting list, when patients at the time of transplantation have less advanced liver disease. LDLT with a GRWR ≥ 5% is related to a higher risk of poor outcome, and thus should be an option for treating selected patients when the risk of a delayed transplantation is high and access to deceased donors is limited.
我们旨在评估活体肝移植（LDLT）后移植物与受者体重比（GRWR）对儿童移植后早期并发症和患者生存率的影响。我们回顾性分析了2004年至2019年接受LDLT的321例患者。受者被分为四组：37例患者的GRWR≤1.5%（A组），196例患者的GRWR>1.5%且≤3.5%（B组），73例患者的GRWR>3.5%且<5%（C组），15例患者的GRWR≥5%（D组）。不同GRWR组之间早期手术并发症的发生率，包括血管并发症、胆道并发症、术后出血、胃肠道穿孔和移植物丢失情况相当。GRWR>3.5%的患者延迟腹部伤口缝合更为常见。GRWR<5%的受者在患者和移植物生存率方面预后明显更好。使用GRWR<5%的移植物可以扩大供体库，并降低等待名单上患者的死亡风险，此时移植时患者的肝病进展较轻。GRWR≥5%的LDLT与不良结局风险较高相关，因此当延迟移植风险高且获取尸体供体受限，它应作为治疗特定患者的一种选择。
