Gad Emad Hamdy, Sallam Ahmed Nabil, Soliman Hosam, Ibrahim Tarek, Salem Tahany Abdel Hameed, Ali Mohammed Abdel-Hafez, Al-Sayed Abd-Same Mohammed, Ayoub Islam
Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt.
Pediatric Hepatology, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt.
Ann Med Surg (Lond). 2022 Jun 7;79:103938. doi: 10.1016/j.amsu.2022.103938. eCollection 2022 Jul.
Pediatric living donor liver transplantation (LDLT) is an effective tool for managing pediatric patients with end-stage liver disease (ESLD) with good long-term graft and patient survival, especially after improvement in peri-operative care, surgical tools and techniques; however, the morbidity and mortality after such a procedure are still a challenging matter. The study aimed to analyze short-and long-term outcomes after pediatric LDLT in a single centre.
We retrospectively analyzed 67 pediatric patients who underwent LDLT in the period from April 2003 to July 2018. The overall male/female ratio was 40/27.
Forty-one (61.2%) of patients had ≥1 early and/or late morbidities; the early (less than 3months) and late (≥3months) ones affected 36(53.7%) and 12(17.9%) of them respectively. The 16-year graft and patient survivals were 35(52.2%) while early and late mortalities were 23(34.3%) and 9(13.4%) respectively. Sepsis and chronic rejection were the most frequent causes of early and late mortalities respectively. Moreover, more packed RBCs transfusion units, bacterial infections, and pulmonary complications were independent predictors of poor patient survival.
More packed RBCs transfusion units intra-operatively, and post-liver transplant (LT) bacterial infection, sepsis, chronic rejection, as well as pulmonary complications had a negative insult on our patients' outcomes, so proper management of them is mandatory for improving outcomes after pediatric LDLT.
小儿活体肝移植（LDLT）是治疗终末期肝病（ESLD）患儿的有效手段，长期移植物和患者生存率良好，尤其是在围手术期护理、手术工具和技术得到改善之后；然而，该手术后的发病率和死亡率仍然是一个具有挑战性的问题。本研究旨在分析单中心小儿LDLT后的短期和长期结果。
我们回顾性分析了2003年4月至2018年7月期间接受LDLT的67例小儿患者。总体男女比例为40/27。
41例（61.2%）患者发生≥1种早期和/或晚期并发症；早期（小于3个月）和晚期（≥3个月）并发症分别影响其中36例（53.7%）和12例（17.9%）。16年移植物和患者生存率分别为35例（52.2%），而早期和晚期死亡率分别为23例（34.3%）和9例（13.4%）。脓毒症和慢性排斥反应分别是早期和晚期死亡的最常见原因。此外，更多单位的浓缩红细胞输注、细菌感染和肺部并发症是患者生存不良的独立预测因素。
术中更多单位的浓缩红细胞输注以及肝移植后细菌感染、脓毒症、慢性排斥反应和肺部并发症对我们患者的预后有负面影响，因此对它们进行适当管理对于改善小儿LDLT后的预后至关重要。
