Li Jie, Pan Yixiao, Lu Yefeng, Zhu Xinye, Ge Jiahao, Tang Siyuan, Zhao Jie, Long Mei, Bo Xiaochen, Zhang Yiqing, Wan Ping, He Kang, Yang Taihua, Xia Qiang
Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
Shanghai Institute of Organ Transplantation, Shanghai, 200127, China.
Hepatol Int. 2025 Jul 18. doi: 10.1007/s12072-025-10851-1.
Pediatric living donor liver transplantation (PLDLT) is a life-saving option for children with end-stage liver diseases. However, the growing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) raises concerns regarding the use of steatotic donor grafts, particularly in vulnerable pediatric populations.
This study retrospectively investigated the impact of steatotic liver grafts on post-transplant outcomes in PLDLT recipients. 905 PLDLT recipients at Renji Hospital, Shanghai Jiao Tong University School of Medicine, from January 2019 to December 2021 were screened using computed tomography (CT) liver/spleen ratio and classified into three groups according to the degree of steatosis. This study evaluated early liver function, post-transplant complications, and long-term graft and patient survival.
Recipients in the moderate-to-severe group exhibited higher incidence of rejection. However, there were no significant differences in early liver function and the 1-year and 3-year graft and patient survival among three groups.
The use of steatotic livers in PLDLT can be considered a viable option, with careful donor selection and vigilant postoperative management. These findings highlight the potential of MASLD as an expansion of the donor pool owing to its rising incidence and offer new insights into optimizing pediatric transplant outcomes while addressing the scarcity of suitable donor organs.
小儿活体肝移植（PLDLT）是终末期肝病患儿的一种挽救生命的选择。然而，代谢功能障碍相关脂肪性肝病（MASLD）患病率的不断上升引发了对脂肪变性供肝使用的担忧，尤其是在脆弱的儿科人群中。
本研究回顾性调查了脂肪变性肝移植对PLDLT受者移植后结局的影响。使用计算机断层扫描（CT）肝脏/脾脏比值对上海交通大学医学院附属仁济医院2019年1月至2021年12月的905例PLDLT受者进行筛查，并根据脂肪变性程度分为三组。本研究评估了早期肝功能、移植后并发症以及长期移植物和患者生存率。
中重度组受者排斥反应发生率较高。然而，三组之间在早期肝功能以及1年和3年移植物和患者生存率方面没有显著差异。
在谨慎选择供体并进行术后密切监测的情况下，PLDLT中使用脂肪变性肝脏可被视为一种可行的选择。这些发现凸显了MASLD因发病率上升而作为扩大供体库的潜力，并为在解决合适供体器官稀缺问题的同时优化小儿移植结局提供了新的见解。
