Yoon Kyung Chul, Song Sanghee, Lee Sanghoon, Kim Ok-Kyung, Hong Suk Kyun, Yi Nam-Joon, Kim Jong Man, Lee Kwang-Woong, Kim Myoung Soo, Choi YoungRok, Suh Kyung-Suk, Lee Suk-Koo
Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Department of Surgery, Seoul National University Boramae Medical Center, Seoul, South Korea.
Ann Transplant. 2022 May 3;27:e935682. doi: 10.12659/AOT.935682.
BACKGROUND The number of pediatric patients awaiting liver transplantation has decreased. Due to its increased use in Korea, split liver transplantation (SLT) may be a substitute for living donor liver transplantation (LDLT); however, the outcomes of pediatric SLT and LDLT in Korea remain unreported. MATERIAL AND METHODS We reviewed data of Korean patients aged <18 years who received SLT from 2005 to 2014, based on the Korea national database and compared to recipients who underwent LDLTs at Seoul National University Hospital during the same period. RESULTS A total of 63 and 56 patients were included in SLT and LDLT, respectively. The most common indication for LT was biliary atresia (60.3% in SLT vs 67.9% in LDLT). The Pediatric End-Stage Liver Disease score did not differ between the groups (P>0.05). The 1-, 3-, and 5-year overall survival rates were 92.1%, 90.2%, and 86.6% in the SLT and 96.4%, 94.6%, and 94.6% in the LDLT groups, respectively (P=0.21); the corresponding graft survival rates were 88.9%, 87.1%, and 83.6% in the SLT and 92.9%, 91.0%, and 91.0% in the LDLT groups, respectively (P=0.31). Fulminant hepatic failure was a risk factor for graft failure [OR, 8.77 (1.08-70.92); P=0.042], but not overall survival [OR, 11.78 (0.56-247.29); P=0.11]. CONCLUSIONS The graft and overall survival rates of SLT and LDLT were not different in pediatric patients in Korea, and fulminant hepatic failure was the only risk factor affecting graft survival outcomes.
等待肝移植的儿科患者数量有所减少。由于劈离式肝移植（SLT）在韩国的应用增加，其可能替代活体供肝肝移植（LDLT）；然而，韩国儿科SLT和LDLT的结果仍未报道。材料与方法：我们基于韩国国家数据库回顾了2005年至2014年接受SLT的18岁以下韩国患者的数据，并与同期在首尔国立大学医院接受LDLT的受者进行比较。结果：SLT和LDLT分别纳入了63例和56例患者。肝移植最常见的适应证是胆道闭锁（SLT中占60.3%，LDLT中占67.9%）。两组间儿童终末期肝病评分无差异（P>0.05）。SLT组1年、3年和5年的总生存率分别为92.1%、90.2%和86.6%，LDLT组分别为96.4%、94.6%和94.6%（P=0.21）；相应的移植物生存率SLT组分别为88.9%、87.1%和83.6%，LDLT组分别为92.9%、91.0%和91.0%（P=0.31）。暴发性肝衰竭是移植物失败的危险因素[比值比（OR），8.77（1.08 - 70.92）；P=0.042]，但不是总生存的危险因素[OR，11.78（0.56 - 247.29）；P=0.11]。结论：在韩国儿科患者中，SLT和LDLT的移植物和总生存率无差异，暴发性肝衰竭是影响移植物生存结果的唯一危险因素。
