Department of Anesthesiology, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, No. 160 Pujian Road, Pudong New District, Shanghai, 200127, China.
Nursing Department, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, No. 160 Pujian Road, Shanghai, China.
World J Pediatr. 2023 Feb;19(2):170-179. doi: 10.1007/s12519-022-00632-3. Epub 2022 Nov 18.
Pediatric liver transplantation is an important modality for treating biliary atresia. The overall survival (OS) rate of pediatric liver transplantation has significantly improved compared with that of 20 years ago, but it is still unsatisfactory. The anesthesia strategy of maintaining low central venous pressure (CVP) has shown a positive effect on prognosis in adult liver transplantation. However, this relationship remains unclear in pediatric liver transplantation. Thus, this study was conducted to review the data of pediatric living-donor liver transplantation to analyze the associations of different CVP levels with the prognosis of recipients.
This was a retrospective study and the patients were divided into two groups according to CVP levels after abdominal closure: low CVP (LCVP) (≤ 10 cmHO, n = 470) and high CVP (HCVP) (> 10 cmHO, n = 242). The primary outcome measured in the study was the overall survival rate. The secondary outcomes included the duration of mechanical ventilation in the intensive care unit (ICU), length of stay in the ICU, and postoperative stay in the hospital. Patient demographic and perioperative data were collected and compared between the two groups. Kaplan-Meier curves were constructed to determine the associations of different CVP levels with the survival rate.
In the study, 712 patients, including 470 in the LCVP group and 242 in the HCVP group, were enrolled. After propensity score matching, 212 pairs remained in the group. The LCVP group showed a higher overall survival rate than the HCVP group in the Kaplan-Meier curves and multivariate Cox regression analyses (P = 0.018), and the HCVP group had a hazard ratio of 2.445 (95% confidence interval, 1.163-5.140).
This study confirmed that a low-CVP level at the end of surgery is associated with improved overall survival and a shorter length of hospital stay.
儿科肝移植是治疗胆道闭锁的重要手段。与 20 年前相比，儿科肝移植的总体生存率（OS）有了显著提高，但仍不理想。在成人肝移植中，维持中心静脉压低（CVP）的麻醉策略对预后有积极影响。然而，这种关系在儿科肝移植中尚不清楚。因此，本研究回顾了儿科活体供肝移植的数据，分析了不同 CVP 水平与受体预后的关系。
这是一项回顾性研究，根据腹部关闭后 CVP 水平将患者分为两组：低 CVP（LCVP）（≤10cmH2O，n=470）和高 CVP（HCVP）（>10cmH2O，n=242）。研究的主要结局是总生存率。次要结局包括 ICU 机械通气时间、ICU 住院时间和住院时间。收集并比较两组患者的人口统计学和围手术期数据。绘制 Kaplan-Meier 曲线以确定不同 CVP 水平与生存率的关系。
本研究共纳入 712 例患者，其中 LCVP 组 470 例，HCVP 组 242 例。在倾向评分匹配后，组内仍有 212 对。LCVP 组 Kaplan-Meier 曲线和多因素 Cox 回归分析显示总体生存率高于 HCVP 组（P=0.018），HCVP 组的危险比为 2.445（95%置信区间，1.163-5.140）。
本研究证实，手术结束时的低 CVP 水平与提高总体生存率和缩短住院时间有关。
