Fu B S, Yi S H, Yi H M, Feng X, Zhang T, Yang Q, Zhang Y C, Yao J, Tang H, Zeng K N, Li X B, Yang Z, Lyu L, Chen G H, Yang Y
Liver Surgery & Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University;Institute of Organ Transplantation,Sun Yat-sen University;Guangdong Organ Transplantation Research Center;Guangdong Transplantation Medical Engineering Laboratory;Guangdong Provincial Key Laboratory of Liver Diseases,Guangzhou 510630,China.
Zhonghua Wai Ke Za Zhi. 2022 Oct 1;60(10):900-905. doi: 10.3760/cma.j.cn112139-20220712-00309.
To compare the clinical efficacy of split liver transplantation (SLT) and living donor liver transplantation(LDLT) in the treatment of children with biliary atresia. The clinical data of 64 children with biliary atresia who underwent SLT and 44 children who underwent LDLT from June 2017 to May 2022 at Liver Surgery & Liver Transplantation Center,the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Among the children who received SLT, there were 40 males and 24 females. The median age at transplantation was 8 months (range:4 to 168 months). Among the patients who received LDLT, there were 24 males and 20 females. The age at transplantation ranged from 4 to 24 months,with a median age of 7 months. Sixty-four children with biliary atresia were divided into two groups according to the SLT operation time: 32 cases in the early SLT group(June 2017 to January 2019) and 32 cases in the technically mature SLT group (February 2019 to May 2022). Rank sum test or test was used to compare the recovery of liver function between the LDLT group and the SLT group,and between the early SLT group and the technically mature SLT group. The incidence of postoperative complications was compared by χ test or Fisher exact probability method. Kaplan-Meier method and Log-rank test were used for survival analysis. The cold ischemia time( (IQR)) (218 (65) minutes), intraoperative blood loss(175 (100) ml) and graft-to-recipient body weight ratio (3.0±0.7) in the LDLT group were lower than those in the SLT group(500 (130) minutes, 200 (250) ml, 3.4±0.8) (=-8.064,=-2.969, =-2.048, all <0.05). The cold ischemia time(457(158)minutes) and total hospital stay ((37.4±22.4)days) in the technically mature SLT group were lower than those in the early SLT group(510(60)minutes, (53.0±39.0)days).The differences were statistically significant (=-2.132, =1.934, both <0.05).The liver function indexes of LDLT group and SLT group showed unimodal changes within 1 week after operation. The peak values of ALT, AST, prothrombin time, activeated partial thromboplasting time, international normalized ratio, fibrinogen and creatinine all appeared at 1 day after operation, and the peak value of prothrombin activity appeared at 3 days after operation. All indicators returned to normal at 7 days after operation. The 1-,2-,and 3-year overall survival rates were 95.5% in LDLT group and 93.5% in the technically mature SLT group, and the difference was not statistically significant. The 1-,2-,and 3-year overall survival rates were 90.2% in the early SLT group and 93.5% in the technically mature SLT group, and there was no significant difference between the two groups(>0.05). The main complications of the early SLT group were surgery-related complications(28.1%,9/32), and the main complications of the technically mature SLT group were non-surgery-related complications(21.9%,7/32). There were 5 deaths in the SLT group,including 4 in the early SLT group and 1 in the technically mature SLT group. The survival rate of SLT in the treatment of biliary atresia is comparable to that of LDLT.
比较劈离式肝移植（SLT）与活体肝移植（LDLT）治疗儿童胆道闭锁的临床疗效。回顾性分析2017年6月至2022年5月在中山大学附属第三医院肝脏外科与肝移植中心接受SLT的64例儿童胆道闭锁患者及接受LDLT的44例儿童的临床资料。接受SLT的儿童中，男性40例，女性24例。移植时的中位年龄为8个月（范围：4至168个月）。接受LDLT的患者中，男性24例，女性20例。移植年龄为4至24个月，中位年龄为7个月。64例儿童胆道闭锁患者根据SLT手术时间分为两组：早期SLT组（2017年6月至2019年1月）32例，技术成熟SLT组（2019年2月至2022年5月）32例。采用秩和检验或检验比较LDLT组与SLT组、早期SLT组与技术成熟SLT组之间肝功能的恢复情况。采用χ检验或Fisher确切概率法比较术后并发症的发生率。采用Kaplan-Meier法和Log-rank检验进行生存分析。LDLT组的冷缺血时间（四分位间距）（218（65）分钟）、术中出血量（175（100）ml）和移植物与受者体重比（3.0±0.7）低于SLT组（500（130）分钟、200（250）ml、3.4±0.8）（z=-8.064，t=-2.969，t=-2.048，均P<0.05）。技术成熟SLT组的冷缺血时间（457（158）分钟）和总住院时间（（37.4±22.4）天）低于早期SLT组（510（60）分钟、（53.0±39.0）天）。差异有统计学意义（t=-2.132，t=1.934，均P<0.05）。LDLT组和SLT组的肝功能指标在术后1周内呈单峰变化。ALT、AST、凝血酶原时间、活化部分凝血活酶时间、国际标准化比值、纤维蛋白原和肌酐的峰值均出现在术后1天，凝血酶原活性峰值出现在术后3天。所有指标在术后7天恢复正常。LDLT组1年、2年和3年总生存率为95.5%，技术成熟SLT组为93.5%，差异无统计学意义。早期SLT组1年、2年和3年总生存率为90.2%，技术成熟SLT组为93.5%，两组间差异无统计学意义（P>0.05）。早期SLT组的主要并发症为手术相关并发症（28.1%，9/32），技术成熟SLT组的主要并发症为非手术相关并发症（21.9%，7/32）。SLT组有5例死亡，其中早期SLT组4例，技术成熟SLT组1例。SLT治疗胆道闭锁的生存率与LDLT相当。
