Costa Carolina Magalhães, Fonseca Eduardo A, Pugliese Renata, Benavides Marcel R, Vincenzi Rodrigo, Rangel Nathália P T, Oliveira Caio M, Roda Karina, Fernandes Debora P, Seda Neto João
Hepatology and Liver Transplantation, Hospital Sirio-Libanes, Sao Paulo, Brazil.
Hepatology and Liver Transplantation, A. C. Camargo Cancer Center, Sao Paulo, Brazil.
World J Pediatr Surg. 2025 Apr 15;8(2):e000975. doi: 10.1136/wjps-2024-000975. eCollection 2025.
The discrepancy in size between donor and recipient presents a complex challenge in pediatric liver transplantation (PLT), often necessitating secondary abdominal closure to prevent abdominal compartment syndrome. The aim of this study is to determine the variables associated with an increased risk of requiring secondary closure in PLT.
The retrospective study analyzed all primary liver transplantations performed in patients under 18 years of age from January 2014 to July 2022. The primary endpoint was the risk of secondary abdominal closure. Variables analyzed included pretransplant status, perioperative and postoperative data.
A total of 664 PLT recipients were identified, of which 58 required secondary abdominal closure (8.7%). Most patients had biliary atresia (=412, 62.0%), followed by metabolic diseases (=78, 11.7%). Statistical difference were found in donor gender (=0.020) and the recipient-to-donor body weight ratio (RDBW), which was lower in the secondary closure group (0.1±0.1 0.2±0.27; =0.001), lower in secondary closure. The mean hospital and intensive care unit (ICU) stay after PLT was significantly longer in the intervention group compared to those with primary abdominal closure (24.4±20.4 days 12.5±13.1 days, <0.001). Multivariable Cox regression analysis identified male donor as an independent risk factor for secondary abdominal closure (hazard ratio 1.9, =0.030).
Patients requiring secondary closure were smaller, had a lower RDBW, and received grafts with a higher graft-to-recipient weight ratio (GRWR), Graft size modulation and secondary abdominal closure are currently the techniques used to prevent compartment syndrome in PLT, particularly for children with low body weight.
供体与受体之间的尺寸差异给小儿肝移植（PLT）带来了复杂的挑战，通常需要进行二期腹壁关闭以预防腹腔间隔室综合征。本研究的目的是确定与小儿肝移植中需要二期关闭风险增加相关的变量。
这项回顾性研究分析了2014年1月至2022年7月在18岁以下患者中进行的所有原位肝移植。主要终点是二期腹壁关闭的风险。分析的变量包括移植前状态、围手术期和术后数据。
共确定了664例小儿肝移植受者，其中58例需要二期腹壁关闭（8.7%）。大多数患者患有胆道闭锁（=412，62.0%），其次是代谢性疾病（=78，11.7%）。在供体性别（=0.020）和受体与供体体重比（RDBW）方面发现了统计学差异，二期关闭组的该比值较低（0.1±0.1对0.2±0.27；=0.001），二期关闭时较低。与一期腹壁关闭的患者相比，干预组小儿肝移植后的平均住院时间和重症监护病房（ICU）住院时间明显更长（24.4±20.4天对12.5±13.1天，<0.001）。多变量Cox回归分析确定男性供体是二期腹壁关闭的独立危险因素（风险比1.9，=0.030）。
需要二期关闭的患者体型较小，RDBW较低，接受的移植物与受体体重比（GRWR）较高，移植物大小调节和二期腹壁关闭是目前用于预防小儿肝移植中腹腔间隔室综合征的技术，特别是对于低体重儿童。
