School of Medicine, Nankai University, Tianjin, China.
Department of Anesthesiology, Tianjin First Central Hospital, Tianjin, China.
BMJ Paediatr Open. 2023 Jul;7(1). doi: 10.1136/bmjpo-2023-001934.
Living donor liver transplantation (LT) is the main treatment for paediatric biliary atresia (BA) in Asia. During LT, a series of haemodynamic changes often occur during LT reperfusion, which is called postreperfusion syndrome (PRS), and PRS is related to a prolonged postoperative hospital stay, delayed recovery of graft function and increased mortality. To reduce adverse reactions after paediatric living donor LT (LDLT), our study's objectives were to ascertain the incidence of PRS and analyse possible risk factors for PRS.
With the approval of the Ethics Committee of our hospital, the clinical data of 304 paediatric patients who underwent LDLT from January 2020 to December 2021 were analysed retrospectively. According to the presence or absence of PRS, the paediatric patients were divided into the non-PRS group and the PRS group. Independent risk factors of PRS were analysed using logistic regression analysis.
PRS occurred in 132 recipients (43.4%). The peak values of AST (816 (507-1625) vs 678 (449-1107), p=0.016) and ALT (675 (415-1402) vs 545 (389-885), p=0.015) during the first 5 days after LDLT in paediatric patients with PRS were significantly higher than those in the non-PRS group. Meanwhile, the paediatric patients in the PRS group had longer intensive care unit stays and hospital stays, as well as lower 1-year survival rates. Graft cold ischaemic time (CIT) ≥90 min (OR (95% CI)=5.205 (3.094 to 8.754)) and a temperature <36°C immediately before reperfusion (OR (95% CI)=2.973 (1.669 to 5.295)) are independent risk factors for PRS.
The occurrence of hypothermia (<36.0℃) in children immediately before reperfusion and graft CIT≥90 min are independent risk factors for PRS. PRS was closely related to the postoperative adverse outcomes of paediatric patients.
亲体肝移植（LT）是亚洲小儿胆道闭锁（BA）的主要治疗方法。在 LT 中，LT 再灌注期间经常会发生一系列血流动力学变化，称为再灌注后综合征（PRS），PRS 与术后住院时间延长、移植物功能恢复延迟和死亡率增加有关。为了减少小儿活体供肝 LT（LDLT）后的不良反应，本研究旨在确定 PRS 的发生率，并分析 PRS 的可能危险因素。
本研究回顾性分析了 2020 年 1 月至 2021 年 12 月期间我院 304 例接受 LDLT 的小儿患者的临床资料，该研究获得了我院伦理委员会的批准。根据是否存在 PRS，将小儿患者分为非 PRS 组和 PRS 组。使用逻辑回归分析分析 PRS 的独立危险因素。
PRS 发生在 132 例受者（43.4%）中。PRS 组患儿在 LDLT 后第 1 至 5 天内，AST（816（507-1625）比 678（449-1107），p=0.016）和 ALT（675（415-1402）比 545（389-885），p=0.015）的峰值显著高于非 PRS 组。同时，PRS 组患儿 ICU 入住时间和住院时间较长，1 年生存率较低。冷缺血时间（CIT）≥90 分钟（OR（95%CI）=5.205（3.094-8.754））和再灌注前体温<36°C（OR（95%CI）=2.973（1.669-5.295））是 PRS 的独立危险因素。
小儿再灌注前体温<36.0℃和 CIT≥90 分钟是 PRS 的独立危险因素。PRS 与小儿患者术后不良结局密切相关。
