Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Transplant Proc. 2022 Mar;54(2):403-405. doi: 10.1016/j.transproceed.2021.09.072. Epub 2022 Jan 10.
To evaluate the significance of portosystemic shunts and associated long-term outcomes in living donor liver transplant (LDLT) among pediatric patients.
Retrospective review of 121 pediatric patients who underwent LDLT between May 1994 and December 2015 at Taiwan Kaohsiung Chang Gung Memorial Hospital. Pre- and postoperative computed tomography images of the liver were reviewed, and portal vein complications were assessed.
Ninety-seven pediatric patients were included in the study, and 70 had portosystemic shunts before transplant. Thirty-three patients have portal systemic shunt (PSS) 6 months after transplant (mean [SD] shunt size, 4.59 [1.98] mm). Thirty-seven patients' portosystemic shunts closed spontaneously (mean [SD] shunt size, 3.14 [1.06] mm). Smaller PSSs tend to close spontaneously with a cutoff point of 3.35 mm by receiver operating characteristic curve (P = .01). Patients with PSS have more portal vein complications than those without PSS (44.3% vs 11.1%, P = .02). Among PSS recipients, patients with portal vein complications tend to have larger PSS size (mean [SD], 4.14 [1.96] mm vs 3.59 [1.48] mm), although the difference is not statistically significant (P = .19).
In pediatric patients, preoperative portosystemic shunts are significantly correlated with portal venous complications, some of which require minimal interventions after LDLT with good outcomes. Shunts larger than 3.35 mm tend to persist after transplant with increased portal venous complications.
评估小儿活体肝移植（LDLT）中门体分流及其相关长期结局的意义。
回顾性分析 1994 年 5 月至 2015 年 12 月在台湾高雄长庚纪念医院接受 LDLT 的 121 例小儿患者的资料。分析术前和术后肝脏的 CT 图像，并评估门静脉并发症。
研究纳入 97 例小儿患者，70 例患者在移植前存在门体分流。33 例患者在移植后 6 个月存在门体分流（分流大小的平均[标准差]为 4.59[1.98]mm）。37 例患者的门体分流自发关闭（分流大小的平均[标准差]为 3.14[1.06]mm）。通过受试者工作特征曲线，较小的门体分流（3.35mm）更倾向于自发关闭（P=0.01）。存在门体分流的患者比不存在门体分流的患者更易发生门静脉并发症（44.3%比 11.1%，P=0.02）。在门体分流的患者中，存在门静脉并发症的患者门体分流的大小更大（平均[标准差]，4.14[1.96]mm 比 3.59[1.48]mm），但差异无统计学意义（P=0.19）。
在小儿患者中，术前门体分流与门静脉并发症显著相关，其中一些患者在 LDLT 后需要进行最小干预，且预后良好。大于 3.35mm 的分流更倾向于在移植后持续存在，增加门静脉并发症的发生风险。
