Lemoine Caroline P, LeShock John P, Brandt Katherine A, Superina Riccardo
Division of Transplant and Advanced Hepatobiliary Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue Box 57, Chicago, IL 60611, USA.
J Clin Med. 2022 May 26;11(11):3012. doi: 10.3390/jcm11113012.
Introduction: Primary liver transplants (pLT) in patients with biliary atresia (BA) are infrequent, since most babies with BA undergo a prior Kasai portoenterostomy (KPE). This study compared transplant outcomes in children with BA with or without a prior KPE. We hypothesized that pLT have less morbidity and better outcomes compared to those done after a failed KPE. Methods: A retrospective review of patients with BA transplanted at our institution was performed. Patients were included if they received a pLT or if they were transplanted less than 2 years from KPE. Outcomes were compared between those groups. Comparisons were also made based on era (early: 1997−2008 vs. modern: 2009−2020). p < 0.05 was considered significant. Results: Patients who received a pLT were older at diagnosis (141.5 ± 46.0 vs. KPE 67.1 ± 25.5 days, p < 0.001). The time between diagnosis and listing for transplant was shorter in the pLT group (44.5 ± 44.7 vs. KPE 140.8 ± 102.8 days, p < 0.001). In the modern era, the calculated PELD score for the pLT was significantly higher (23 ± 8 vs. KPE 16 ± 8, p = 0.022). Two waitlist deaths occurred in the KPE group (none in pLT, p = 0.14). Both the duration of transplant surgery and transfusion requirements were similar in both groups. There was a significant improvement in graft survival in transplants after KPE between eras (early era 84.3% vs. modern era 97.8%, p = 0.025). The 1-year patient and graft survival after pLT was 100%. Conclusions: Patient and graft survival after pLT are comparable to transplants after a failed KPE but pLT avoids a prior intervention. There was no significant difference in pre- or peri-transplant morbidity between groups other than wait list mortality. A multicenter collaboration with more patients may help demonstrate the potential benefits of pLT in patients predicted to have early failure of KPE.
由于大多数患有胆道闭锁（BA）的婴儿之前都接受过Kasai肝门空肠吻合术（KPE），因此原发性肝移植（pLT）在BA患者中并不常见。本研究比较了有或没有先前KPE的BA儿童的移植结局。我们假设与KPE失败后进行的肝移植相比，pLT的发病率更低，结局更好。方法：对在我们机构接受移植的BA患者进行回顾性研究。如果患者接受了pLT，或者在KPE后不到2年接受移植，则纳入研究。比较两组之间的结局。还根据时代（早期：1997 - 2008年与现代：2009 - 2020年）进行了比较。p < 0.05被认为具有统计学意义。结果：接受pLT的患者诊断时年龄更大（141.5 ± 46.0天 vs. KPE组67.1 ± 25.5天，p < 0.001）。pLT组从诊断到列入移植名单的时间更短（44.5 ± 44.7天 vs. KPE组140.8 ± 102.8天，p < 0.001）。在现代时代，pLT计算的PELD评分显著更高（23 ± 八 vs. KPE组16 ± 八，p = 0.022）。KPE组发生了2例等待名单死亡（pLT组无死亡，p = 0.14）。两组的移植手术持续时间和输血需求相似。不同时代KPE后移植的移植物存活率有显著提高（早期84.3% vs. 现代97.8%，p = 0.025）。pLT后1年的患者和移植物存活率为百分之百。结论：pLT后的患者和移植物存活率与KPE失败后的移植相当，但pLT避免了先前的干预。除了等待名单死亡率外，两组之间移植前或移植围手术期的发病率没有显著差异。与更多患者进行多中心合作可能有助于证明pLT对预计KPE早期失败患者的潜在益处。
