Pediatric Surgery and Transplant Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
Abdominal Transplant Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
Pediatr Transplant. 2024 Nov;28(7):e14861. doi: 10.1111/petr.14861.
The concept of failure to rescue (FTR) has been used to evaluate the quality of care in several surgical specialties but has not been well-studied after living donor liver transplantation (LDLT) in children.
This study retrospectively reviewed 500 pediatric LDLT performed at a single center between 1993 and 2022. The recipient outcomes were assessed by means of patient and graft survival rates, retransplantation rates, and arterial/portal/biliary complication rates. Graft and patient losses secondary to these complications were calculated regarding FTR for patients (FTRp) and grafts (FTRg).
Overall 1- and 5-year patient survival rates were 94.5% and 92.1%, respectively, the corresponding figures for graft survival being 92.7% and 89.8%. One-year hepatic artery complication rate was 3.6% (n = 18 cases), the respective rates for portal vein complications and biliary complications being 5.7% (n = 57) and 15.6% (n = 101). One-year FTRp rates for hepatic artery thrombosis, portal vein thrombosis, anastomotic biliary stricture, and intrahepatic biliary stricture were 28.6%, 9.4%, 3.6%, and 0%, respectively. The corresponding FTRg rates being 21.4%, 6.3%, 0%, and 36.4%.
Such novel analytical method may offer valuable insights for optimizing quality of care in pediatric LDLT.
失败救援（FTR）的概念已被用于评估多个外科专业的护理质量，但在儿童活体肝移植（LDLT）后尚未得到充分研究。
本研究回顾性分析了 1993 年至 2022 年期间在一家单中心进行的 500 例小儿 LDLT。通过患者和移植物存活率、再次移植率以及动脉/门静脉/胆管并发症率评估受体结局。计算因这些并发症导致的移植物和患者损失的 FTRp 和 FTRg。
总体而言，1 年和 5 年患者存活率分别为 94.5%和 92.1%，相应的移植物存活率分别为 92.7%和 89.8%。1 年肝动脉并发症发生率为 3.6%（n=18 例），门静脉并发症和胆管并发症的相应发生率分别为 5.7%（n=57）和 15.6%（n=101）。1 年肝动脉血栓形成、门静脉血栓形成、吻合口胆管狭窄和肝内胆管狭窄的 FTRp 发生率分别为 28.6%、9.4%、3.6%和 0%，相应的 FTRg 发生率分别为 21.4%、6.3%、0%和 36.4%。
这种新的分析方法可为优化小儿 LDLT 的护理质量提供有价值的见解。
