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比较胆道闭锁患者行 Kasai 术前与术后肝移植结局:单中心 72 例分析。

Comparison of Liver Transplant Outcomes in Biliary Atresia Patients, Considering Whether They Underwent the Kasai Procedure Beforehand: A Single Center Analysis of 72 Patients.

机构信息

Department of General Surgery, Ege University Hospital, Izmir, Turkey.

Department of General Surgery, Ege University Hospital, Izmir, Turkey.

出版信息

Transplant Proc. 2023 Jun;55(5):1199-1208. doi: 10.1016/j.transproceed.2023.04.034. Epub 2023 Jun 10.

DOI:10.1016/j.transproceed.2023.04.034
PMID:37308339
Abstract

BACKGROUND

This study examines the results of liver transplantation (LT) in patients with biliary atresia, considering whether they underwent the Kasai procedure beforehand. LT and determine postoperative and long-term graft outcomes.

METHODS

This single-center, retrospective study included 72 pediatric patients diagnosed with postpartum biliary atresia who underwent LT between 2010 and 2022. We included patients who underwent LT either after or without the Kasai procedure and compared the demographic data of the patients with various factors, such as the Pediatric End-Stage Liver Disease scores and laboratory values.

RESULTS

The study included 72 patients, with 39 of them being female (54.2%) and 33 of them being male (45.8%). Of the 72 patients in the study, 47 (65.3%) had undergone the Kasai procedure, and 25 (34.7%) had not. The preoperative and postoperative month 1 bilirubin values were lower in patients who underwent the Kasai procedure and were higher in postoperative months 3 and 6. Preoperative bilirubin values, postoperative month 3 bilirubin values, and preoperative albumin values were higher in patients who developed mortality (P < .05). Cold ischemia time was longer in patients who developed mortality (P < .05).

CONCLUSIONS

Our study showed a higher mortality rate in patients who underwent the Kasai procedure. The results also showed that LT was more effective in children, as patients with Kasai had higher mean bilirubin values and higher preoperative albumin values than patients without Kasai.

摘要

背景

本研究探讨了胆道闭锁患者肝移植(LT)的结果,考虑了他们是否事先接受了 Kasai 手术。LT 并确定术后和长期移植物的结果。

方法

这项单中心回顾性研究纳入了 2010 年至 2022 年间接受 LT 的 72 例产后胆道闭锁的儿科患者。我们纳入了那些接受 LT 的患者,无论是在 Kasai 手术后还是没有接受 Kasai 手术,并比较了患者的人口统计学数据和各种因素,如儿科终末期肝病评分和实验室值。

结果

研究包括 72 例患者,其中 39 例为女性(54.2%),33 例为男性(45.8%)。在研究的 72 例患者中,47 例(65.3%)接受了 Kasai 手术,25 例(34.7%)未接受。接受 Kasai 手术的患者术前和术后第 1 个月的胆红素值较低,而术后第 3 个月和第 6 个月的胆红素值较高。发生死亡的患者术前胆红素值、术后第 3 个月胆红素值和术前白蛋白值较高(P <.05)。发生死亡的患者冷缺血时间较长(P <.05)。

结论

我们的研究表明,接受 Kasai 手术的患者死亡率较高。结果还表明,LT 在儿童中更有效,因为 Kasai 组的患者平均胆红素值较高,术前白蛋白值较高,而无 Kasai 组的患者则较低。

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