2010年至2020年伊朗一家转诊移植中心儿科部分肝移植的特征与结果
Characteristics and Outcome of Partial Liver Transplant among Pediatrics in a Referral Transplant Center in Iran from 2010 to 2020.
作者信息
Vatankhah Pooya, Khosravi Mohammad Bagher, Eghbal Mohammad Hossein, Asmarian Naeimehossadat, Sahmeddini Mohammad Ali, Khalili Fatemeh, Ghazanfar Tehran Samaneh, Nikoupour Hamed, Shamsaeefar Alireza, Kazemi Kourosh, Sohrabi Nazari Sahar, Nikeghbalian Saman, Malekhosseini Seyed Ali
机构信息
Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz Transplant Center, Abu-Alisina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
出版信息
Iran J Med Sci. 2025 Jun 1;50(6):376-385. doi: 10.30476/ijms.2024.102949.3608. eCollection 2025 Jun.
BACKGROUND
Liver transplantation (LT) is a critical intervention for pediatric patients with advanced liver failure. This study aimed to assess the impact of perioperative factors on LT outcomes in pediatric patients.
METHODS
This retrospective cohort study, conducted from 2010-2020, included 563 pediatric patients who underwent LT in Shiraz, Iran. Most patients received liver grafts from living donors due to cholestatic and metabolic diseases, and all had complete medical and laboratory records. Data were analyzed using various regression models (Cox, linear, and logistic) in SPSS software (version 22).
RESULTS
Of the 563 patients who underwent LT, 436 received livers from living donors and 127 from deceased donors. The primary diagnoses included cholestatic diseases (44.4%) and metabolic diseases (34.1%). Post-transplant rejection and mortality rates were 21.1% (119 patients) and 36.1% (203 patients), respectively. Preoperative factors associated with rejection included weight (HR=1.01, P=0.01) and albumin (HR=0.69, P=0.03). Postoperative factors influencing rejection included platelet transfusion (HR=2.12, P=0.03), primary non-function (PNF) (HR=4.6, P=0.01), cytomegalovirus (CMV)(HR=1.78, P=0.005), and convulsion (HR=1.93, P=0.007). Preoperative factors that affect mortality were age (HR=0.89, P<0.001), alanine aminotransferase (ALT) (HR=1, P=0.047), and hemoglobin levels (HR=0.91, P=0.03). Intraoperative factors influencing mortality included cold ischemia duration (HR=0.98, P=0.048) and anhepatic blood loss (HR=1.02, P<0.001). Postoperative factors associated with mortality included fresh frozen plasma (FFP) transfusion (HR=1.7, P=0.004), bleeding (HR=2.17, P=0.009), bowel perforation (HR=2.55, P=0.01), and PNF (HR=11.24, P<0.001).
CONCLUSION
Optimizing perioperative care practices could significantly improve LT outcomes in pediatric patients.
背景
肝移植（LT）是晚期肝衰竭小儿患者的关键干预措施。本研究旨在评估围手术期因素对小儿肝移植患者预后的影响。
方法
这项回顾性队列研究于2010年至2020年进行，纳入了在伊朗设拉子接受肝移植的563例小儿患者。大多数患者因胆汁淤积和代谢性疾病接受活体供体肝脏移植，且所有患者均有完整的医疗和实验室记录。使用SPSS软件（版本22）中的各种回归模型（Cox、线性和逻辑回归）对数据进行分析。
结果
在563例接受肝移植的患者中，436例接受活体供体肝脏，127例接受尸体供体肝脏。主要诊断包括胆汁淤积性疾病（44.4%）和代谢性疾病（34.1%）。移植后排斥反应和死亡率分别为21.1%（119例患者）和36.1%（203例患者）。与排斥反应相关的术前因素包括体重（HR=1.01，P=0.01）和白蛋白（HR=0.69，P=0.03）。影响排斥反应的术后因素包括血小板输注（HR=2.12，P=0.03）、原发性无功能（PNF）（HR=4.6，P=0.01）、巨细胞病毒（CMV）（HR=1.78，P=0.005）和惊厥（HR=1.93，P=0.007）。影响死亡率的术前因素是年龄（HR=0.89，P<0.001）、丙氨酸氨基转移酶（ALT）（HR=1，P=0.047）和血红蛋白水平（HR=0.91，P=0.03）。影响死亡率的术中因素包括冷缺血时间（HR=0.98，P=0.048）和无肝期失血（HR=1.02，P<0.001）。与死亡率相关的术后因素包括新鲜冰冻血浆（FFP）输注（HR=1.7，P=0.004）、出血（HR=2.17，P=0.009）、肠穿孔（HR=2.55，P=0.01）和PNF（HR=11.24，P<0.001）。
结论
优化围手术期护理措施可显著改善小儿肝移植患者的预后。
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