University of Texas Southwestern Medical Center, Dallas, TX, USA.
Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ann Transplant. 2024 Aug 6;29:e944245. doi: 10.12659/AOT.944245.
BACKGROUND Little is known about outcomes of pediatric patients transplanted using donor liver grafts with abnormal biopsy results. We assessed donor liver biopsy data to report characteristics and outcomes of abnormal livers transplanted in pediatric patients. MATERIAL AND METHODS We identified pediatric patients who received a liver transplant from a biopsied deceased donor between 2015 and 2022 using the national database UNOS Standard Transplant Analysis and Research files. Recipients were excluded if they received multi-organ transplants or were lost to follow-up. Livers with ≤5% macrosteatosis, no fibrosis, and no inflammation were classified as normal livers (NL). Allografts with >5% macrosteatosis, any fibrosis, or any inflammation were considered abnormal livers (AL). Donor and recipient demographic data and outcomes were examined. RESULTS Of the 3808 total pediatric liver transplants in the study period, there were 213 biopsied donor liver allografts transplanted into pediatric recipients. Of those, 114 were NL and 99 were AL. 35.4% (35/99) of the AL had >5% macrosteatosis with a mean of 7.6±11.4%, 64.6% (64/99) had any inflammation, and 18.2% (18/99) had any fibrosis. AL donors were significantly older than NL donors. AL recipients had higher PELD scores. There were no significant differences in length of stay, rejection rates and causes, or allograft survival between AL and NL. Multivariable analysis revealed that inflammation was independently associated with a significantly greater risk for graft failure. CONCLUSIONS Outcomes of abnormal livers are excellent. Inflammation was an independent risk factor for poor graft prognosis. Donor biopsies in pediatric liver transplantation can be a useful adjunct to assess outcomes.
对于使用活检结果异常的供体肝移植的儿科患者，其结局知之甚少。我们评估了供体肝活检数据，以报告在儿科患者中移植异常肝脏的特征和结局。
我们使用国家数据库 UNOS 标准移植分析和研究文件，确定了 2015 年至 2022 年间接受活检已故供体肝移植的儿科患者。如果患者接受多器官移植或失访，则将其排除在外。将≤5% 宏观脂肪变性、无纤维化且无炎症的肝脏归类为正常肝脏（NL）。将>5% 宏观脂肪变性、任何纤维化或任何炎症的同种异体移植物视为异常肝脏（AL）。检查了供体和受者的人口统计学数据和结局。
在研究期间的 3808 例儿科肝移植中，有 213 例供体肝活检移植物被移植到儿科受者体内。其中 114 例为 NL，99 例为 AL。35.4%（35/99）的 AL 存在>5%的宏观脂肪变性，平均为 7.6±11.4%，64.6%（64/99）存在任何炎症，18.2%（18/99）存在任何纤维化。AL 供体明显比 NL 供体年龄大。AL 受者的 PELD 评分更高。AL 和 NL 之间在住院时间、排斥反应率和原因或移植物存活率方面无显著差异。多变量分析显示，炎症是移植物失功的独立危险因素。
异常肝脏的结局良好。炎症是移植物预后不良的独立危险因素。在儿科肝移植中，供体活检可以作为评估结局的有用辅助手段。
