柏林夏里特大学医学中心30多年的小儿肝移植历程。

Over 30 Years of Pediatric Liver Transplantation at the Charité-Universitätsmedizin Berlin.

作者信息

Moosburner Simon, Wiering Leke, Gül-Klein Safak, Ritschl Paul, Dziodzio Tomasz, Raschzok Nathanael, Witzel Christian, Gratopp Alexander, Henning Stephan, Bufler Philip, Schmelzle Moritz, Lurje Georg, Schöning Wenzel, Pratschke Johann, Globke Brigitta, Öllinger Robert

机构信息

Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.

BIH Charité Clinician Scientist Program, Berlin Institute of Health (BIH), 10178 Berlin, Germany.

出版信息

J Clin Med. 2022 Feb 9;11(4):900. doi: 10.3390/jcm11040900.

DOI:10.3390/jcm11040900

PMID:35207173

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8880346/

Abstract

BACKGROUND

Pediatric liver transplantation (LT) is the treatment of choice for children with end-stage liver disease and in certain cases of hepatic malignancies. Due to low case numbers, a technically demanding procedure, the need for highly specialized perioperative intensive care, and immunological, as well as infectious, challenges, the highest level of interdisciplinary cooperation is required. The aim of our study was to analyze short- and long-term outcomes of pediatric LT in our center.

METHODS

We conducted a retrospective single-center analysis of all liver transplantations in pediatric patients (≤16 years) performed at the Department of Surgery, Charité - Universitätsmedizin Berlin between 1991 and 2021. Three historic cohorts (1991-2004, 2005-2014 and 2015-2021) were defined. Graft- and patient survival, as well as perioperative parameters were analyzed. The study was approved by the institutional ethics board.

RESULTS

Over the course of the 30-year study period, 212 pediatric LTs were performed at our center. The median patient age was 2 years (IQR 11 years). Gender was equally distributed (52% female patients). The main indications for liver transplantation were biliary atresia (34%), acute hepatic necrosis (27%) and metabolic diseases (13%). The rate of living donor LT was 25%. The median cold ischemia time for donation after brain death (DBD) LT was 9 h and 33 min (IQR 3 h and 46 min). The overall donor age was 15 years for DBD donors and 32 years for living donors. Overall, respective 1, 5, 10 and 30-year patient and graft survivals were 86%, 82%, 78% and 65%, and 78%, 74%, 69% and 55%. One-year patient survival was 85%, 84% and 93% in the first, second and third cohort, respectively ( = 0.14). The overall re-transplantation rate was 12% ( = 26), with 5 patients (2%) requiring re-transplantation within the first 30 days.

CONCLUSION

The excellent long-term survival over 30 years showcases the effectiveness of liver transplantation in pediatric patients. Despite a decrease in DBD organ donation, patient survival improved, attributed, besides refinements in surgical technique, mainly to improved interdisciplinary collaboration and management of perioperative complications.

摘要

背景

小儿肝移植（LT）是终末期肝病患儿以及某些肝脏恶性肿瘤患儿的首选治疗方法。由于病例数量少、手术技术要求高、需要高度专业化的围手术期重症监护以及免疫和感染方面的挑战，因此需要最高水平的跨学科合作。我们研究的目的是分析本中心小儿肝移植的短期和长期结果。

方法

我们对1991年至2021年期间在柏林夏里特大学医学中心外科进行的所有小儿患者（≤16岁）肝移植进行了回顾性单中心分析。定义了三个历史队列（1991 - 2004年、2005 - 2014年和2015 - 2021年）。分析了移植物和患者的生存率以及围手术期参数。该研究获得了机构伦理委员会的批准。

结果

在30年的研究期间，我们中心共进行了212例小儿肝移植。患者中位年龄为2岁（四分位间距11岁）。性别分布均衡（女性患者占52%）。肝移植的主要适应证为胆道闭锁（34%）、急性肝坏死（27%）和代谢性疾病（13%）。活体供肝肝移植率为25%。脑死亡后供肝肝移植（DBD）的中位冷缺血时间为9小时33分钟（四分位间距3小时46分钟）。DBD供者的总体供者年龄为15岁，活体供者为32岁。总体而言，1年、5年、10年和30年的患者及移植物生存率分别为86%、82%、78%和65%，以及78%、74%、69%和55%。第一、第二和第三队列的1年患者生存率分别为85%、84%和93%（P = 0.14）。总体再次移植率为12%（n = 26），其中5例患者（2%）在术后30天内需要再次移植。