比较活体供肝与劈离式供肝在儿童肝移植中获得的长期疗效。

Comparison of Long-Term Outcomes Achieved With Live Donor and Split Deceased Donor Liver Grafts in Pediatric Liver Transplantation.

机构信息

New Zealand Liver Transplant Unit, Te Toka Tumai, Auckland, New Zealand.

Department of Surgery, University of Auckland, Auckland, New Zealand.

出版信息

Pediatr Transplant. 2024 Sep;28(6):e14843. doi: 10.1111/petr.14843.

DOI:10.1111/petr.14843

PMID:39158057

Abstract

BACKGROUND

The aim of the present study was to compare the outcomes of pediatric LT with left liver grafts, obtained either from a living donor (LD) or a split deceased donor (sDD).

METHODS

Retrospective single-center study from 2002 to 2022. All pediatric LT with left liver grafts (not including middle hepatic vein) from LD or sDD were included. Reduced grafts were not included.

RESULTS

A total of 112 pediatric LT were performed: 58 with LD grafts and 54 with sDD grafts (17 split ex situ and 37 in situ). Donor characteristics were similar, apart from donor age (33 years in LD vs. 30 years in sDD, p = 0.03). Indications were similar with 55% biliary atresia in each group. Retransplantation was more frequently performed in the sDD group (2% vs. 15%, p = 0.01). Recipient age, weight, and PELD score at transplant were not significantly different between groups. Cold ischemia time was longer for sDD (158 min in LD vs. 390 min in sDD; p < 0.0001). Posttransplant peak ALT was higher with sDD grafts (1470 vs. 1063, p = 0.018), and hospital stay was longer with sDD grafts (27 vs. 21 days, p = 0.005). However, there was no difference between groups in terms of major morbidity (Dindo-Clavien grade ≥3), vascular and biliary complications, and 90-day mortality. Patient survival at 10 years was 93.1% for LD and 92.8% for sDD (p = 0.807). Graft survival at 10 years was 89.7% for LD and 83.1% for sDD (p = 0.813).

CONCLUSIONS

Technically similar LD and sDD grafts achieve very similar postoperative and long-term outcomes with excellent patient and graft survival.

摘要

背景

本研究旨在比较使用活体供者（LD）或分割已故供者（sDD）获取的左肝移植物进行小儿肝移植（LT）的结果。

方法

回顾性单中心研究，时间范围为 2002 年至 2022 年。纳入所有使用 LD 或 sDD 供者的左肝移植物（不包括中肝静脉）进行的小儿 LT。不包括减小的移植物。

结果

共进行了 112 例小儿 LT：58 例使用 LD 移植物，54 例使用 sDD 移植物（17 例离体分割和 37 例原位分割）。除供者年龄外（LD 为 33 岁，sDD 为 30 岁，p=0.03），供者特征相似。两组的适应证相似，各有 55%的胆道闭锁。sDD 组更频繁地进行再次移植（2%对 15%，p=0.01）。两组间受体的年龄、体重和移植时 PELD 评分无显著差异。sDD 的冷缺血时间较长（LD 为 158 分钟，sDD 为 390 分钟；p<0.0001）。sDD 移植物的术后丙氨酸转氨酶峰值更高（1470 对 1063，p=0.018），sDD 移植物的住院时间更长（27 对 21 天，p=0.005）。然而，两组间在主要发病率（Dindo-Clavien 分级≥3）、血管和胆道并发症以及 90 天死亡率方面无差异。LD 的 10 年患者生存率为 93.1%，sDD 为 92.8%（p=0.807）。LD 的 10 年移植物生存率为 89.7%，sDD 为 83.1%（p=0.813）。