Pediatric Surgery Unit, Department of Pediatrics, Gynecology, and Obstetrics, Swiss Pediatric Liver Center, University Center of Pediatric Surgery of Western Switzerland, University of Geneva, Geneva, Switzerland.
Pediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Pediatrics, Gynecology, and Obstetrics, Swiss Pediatric Liver Center, University of Geneva, Geneva, Switzerland.
Pediatr Transplant. 2022 Mar;26(2):e14186. doi: 10.1111/petr.14186. Epub 2021 Nov 5.
Patients who have a prolonged stay in the intensive care unit (ICU) are often excluded for organ donation because of supposed deleterious effects of a lengthy ICU stay. We aimed to determine the effects of a prolonged donor stay in the ICU on the outcome of liver transplantation (LT) in children.
Retrospective review of 89 pediatric LT patients, age 0-18 years, period 2003-2018, including patients having undergone whole organ or in situ split LT. The patients were divided into two groups according to the donor length of stay in the ICU. A prolonged stay was defined as >5 days. Recipient, graft, and donor characteristics were compared; outcome parameters included recipient and graft survival rates and postoperative complications.
Group short (donor ICU stay <5 days) included 75 patients, group long (donor ICU stay >5 days) 14 patients. Baseline characteristics between recipients did not differ. Donors in group long had significantly more infectious complications and a higher gamma glutamyl transferase (gGT) the day of organ recovery. Incidence of biliary complications post-LT was significantly higher in group long (p = .029). Patient and graft survival rates did not differ significantly between groups.
Donors with a prolonged stay in the ICU should still be considered for liver donation if they fulfill most other selection criteria. Recipients from donors having stayed in ICU >5 days may be at increased risk of biliary complications.
由于 ICU 住院时间过长可能会产生有害影响，因此在 ICU 住院时间过长的患者通常被排除在器官捐献之外。我们旨在确定 ICU 中供体停留时间延长对儿童肝移植（LT）结局的影响。
回顾性分析了 2003 年至 2018 年间 89 例年龄 0-18 岁的小儿 LT 患者的资料，包括接受过全器官或原位劈裂 LT 的患者。根据供体在 ICU 中的停留时间将患者分为两组。长时间停留定义为 >5 天。比较患者、移植物和供体的特征；结果参数包括受者和移植物的生存率和术后并发症。
组短（供体 ICU 停留时间 <5 天）包括 75 例患者，组长（供体 ICU 停留时间 >5 天）包括 14 例患者。两组受者的基线特征无差异。组长大的供体有明显更多的感染性并发症和更高的谷氨酰转移酶（gGT）在器官恢复当天。组长大的患者 LT 后胆并发症的发生率显著更高（p =.029）。两组患者和移植物的生存率无显著差异。
如果符合大多数其他选择标准，ICU 中长时间停留的供体仍应考虑进行肝捐献。来自 ICU 住院时间超过 5 天的供体的受者可能有更高的胆道并发症风险。
