Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.
University Children's Hospital Regensburg (KUNO), University Medical Center Regensburg, Regensburg, Germany.
Pediatr Transplant. 2024 Mar;28(2):e14699. doi: 10.1111/petr.14699.
Pediatric liver transplantations generally represent advanced surgery for selected patients. In case of acute or chronic graft failure, biliary or vessel complications, a retransplantation (reLT) can be necessary. In these situations massive adhesions, critical patient condition or lack of good vessels for anastomosis often are problematic.
Between 2008 and 2021, 208 pediatric patients received a liver transplantation at our center. Retrospectively, all cases with at least one retransplantation were identified and stored in a database. Indication, intra- and postoperative course and overall survival (OS) were analyzed.
Altogether 31 patients (14.9%) received a reLT. In 22 cases only one reLT was done, 8 patients received 2 reLTs and 1 patient needed a fourth graft. Median age for primary transplantation, first, second and third reLT was 14 (range: 1-192 months), 60.5 (range: 1-215 months), 58.5 (range: 14-131 months) and 67 months, respectively. Although biliary atresia (42%) and acute liver failure (23%) represented the main indications for the primary liver transplantation, acute and chronic graft failure (1st reLT: 36%, 2nd reLT: 38%), hepatic artery thrombosis (1st reLT: 29%, 2nd reLT: 25%, 3rd reLT: 100%) and biliary complications (1st reLT: 26%, 2nd reLT: 37%) were the most frequent indications for reLT. OS was 81.8% for patients with 1 reLT, 87.5% with 2 reLTs and 100% with 3 reLTs.
Pediatric liver retransplantation is possible with a good outcome even after multiple retransplantations in specialized centers. Nevertheless, careful patient and graft selection, as well as good preoperative conditioning, are essential.
儿科肝移植通常代表为选定患者进行的高级手术。在急性或慢性移植物失功、胆道或血管并发症的情况下，可能需要再次移植（reLT）。在这些情况下，大量粘连、患者病情危急或缺乏良好的吻合血管通常是个问题。
2008 年至 2021 年期间，我们中心共为 208 名儿科患者进行了肝移植。回顾性地，确定了所有至少有一次再移植的病例，并将其存储在数据库中。分析了适应证、围手术期过程和总生存率（OS）。
共有 31 名患者（14.9%）接受了 reLT。在 22 例中仅进行了一次 reLT，8 例患者进行了 2 次 reLT，1 例患者需要第 4 次移植。初次移植、第一次、第二次和第三次 reLT 的中位年龄分别为 14（范围：1-192 个月）、60.5（范围：1-215 个月）、58.5（范围：14-131 个月）和 67 个月。尽管胆道闭锁（42%）和急性肝衰竭（23%）是初次肝移植的主要适应证，但急性和慢性移植物失功（第一次 reLT：36%，第二次 reLT：38%）、肝动脉血栓形成（第一次 reLT：29%，第二次 reLT：25%，第三次 reLT：100%）和胆道并发症（第一次 reLT：26%，第二次 reLT：37%）是 reLT 的最常见适应证。有 1 次 reLT 的患者 OS 为 81.8%，有 2 次 reLTs 的患者 OS 为 87.5%，有 3 次 reLTs 的患者 OS 为 100%。
即使在专门中心进行多次再移植，儿科肝再移植也是可能的，且结果良好。然而，仔细的患者和移植物选择，以及良好的术前调理是至关重要的。
