Prachuapthunyachart Sittichoke, Sintusek Palittiya, Tubjareon Chomchanat, Chaijitraruch Nataruks, Sanpavat Anapat, Phewplung Teerasak, Wanawongsawad Piyaporn, Intrarakamhang Ai-Lada, Chongsrisawat Voranush
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
Excellence Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand.
World J Hepatol. 2022 Mar 27;14(3):583-591. doi: 10.4254/wjh.v14.i3.583.
Liver transplantation (LT) has become an acceptable curative method for children with several liver diseases, especially irreversible acute liver failure and chronic liver diseases. King Chulalongkorn Memorial Hospital is one of Thailand's largest liver transplant centers and is responsible for many pediatric cases.
To report the experience with pediatric LT and evaluate outcomes of living-related deceased-donor grafts.
This evaluation included children who underwent LT between August 2004 and November 2019. Data were retrospectively reviewed, including demographics, diagnoses, laboratory values of donors and recipients, the pediatric end-stage liver disease (PELD) or model for end-stage liver disease (MELD) score, graft source, wait time, perioperative course, postoperative complications, and survival rates. Continuous data were reported using the median and interquartile range. The Mann-Whitney test was used to compare the wait time between the living-related and deceased-donor groups. The chi-square or Fisher's exact test were used to compare the frequencies of between-group complications. Survival rates were calculated using the Kaplan-Meier method.
Ninety-four operated pediatric liver transplant patients were identified (54% were females). The median age at transplantation was 1.2 (0.8-3.8) years. The median PELD and MELD scores were 20 (13-26.8) and 19.5 (15.8-26.3), respectively. Most grafts (81.9%) were obtained from living-related donors. The median wait time for the living donors was significantly shorter compared with the deceased donors at 1.6 (0.3-3.1) mo 11.2 (2.1-33.3) mo ( = 0.01). Most patients were diagnosed with biliary atresia (74.5%), and infection was the most common complication within 30 d post-transplantation (14.9%). Without a desensitization protocol, 9% of transplants were ABO-incompatible. Eight hepatitis B core antibodies (anti-HBc)-negative recipients received positive anti-HBc grafts without different observed complications. The overall survival rate was 93.6% and 90.3% at 1 and 5 years, respectively. No graft loss during follow-up was noted among survivors.
A significant number of pediatric LT cases were reported in Thailand. Based on relatively comparable outcomes, ABO-incompatible and HBc antibody-positive grafts may be considered in an organ shortage situation.
肝移植（LT）已成为治疗多种肝病患儿的一种可接受的治愈方法，尤其是不可逆性急性肝衰竭和慢性肝病。朱拉隆功国王纪念医院是泰国最大的肝移植中心之一，负责许多儿科病例。
报告小儿肝移植经验并评估活体亲属供体移植物和尸体供体移植物的结果。
本评估纳入了2004年8月至2019年11月期间接受肝移植的儿童。对数据进行回顾性分析，包括人口统计学、诊断、供体和受体的实验室值、小儿终末期肝病（PELD）或终末期肝病模型（MELD）评分、移植物来源、等待时间、围手术期过程、术后并发症和生存率。连续数据采用中位数和四分位数间距报告。采用Mann-Whitney检验比较活体亲属供体组和尸体供体组的等待时间。采用卡方检验或Fisher精确检验比较组间并发症的发生率。生存率采用Kaplan-Meier法计算。
共确定94例接受肝移植手术的小儿患者（54%为女性）。移植时的中位年龄为1.2（0.8 - 3.8）岁。PELD和MELD评分的中位数分别为20（13 - 26.8）和19.5（15.8 - 26.3）。大多数移植物（81.9%）来自活体亲属供体。活体供体的中位等待时间明显短于尸体供体，分别为1.6（0.3 - 3.1）个月和11.2（2.1 - 33.3）个月（P = 0.01）。大多数患者被诊断为胆道闭锁（74.5%），感染是移植后30天内最常见的并发症（14.9%）。在没有脱敏方案的情况下，9%的移植为ABO血型不相容。8例乙肝核心抗体（抗-HBc）阴性的受者接受了抗-HBc阳性的移植物，未观察到不同的并发症。1年和5年的总生存率分别为93.6%和90.3%。随访期间幸存者未出现移植物丢失。
泰国报告了大量小儿肝移植病例。基于相对可比的结果，在器官短缺的情况下可考虑ABO血型不相容和抗-HBc抗体阳性的移植物。
