胆道闭锁的紧急肝移植：比塞特尔的经验

Urgent liver transplantation for biliary atresia: the experience in Bicêtre.

作者信息

Gauthier F, Chardot C, Branchereau S, Okawa Y, de Dreuzy O, Jacolot D, Devictor D, Debray D, Valayer J

机构信息

Service de Chirurgie Pédiatrique, Centre Hospitalier Universitaire Bicêtre, Faculté de Médecine Paris Sud, Université Paris 11, Le Kremlin Bicêtre, France.

出版信息

Tohoku J Exp Med. 1997 Jan;181(1):129-38. doi: 10.1620/tjem.181.129.

DOI:10.1620/tjem.181.129

PMID:9149347

Abstract

According to French rules for cadaver organ sharing, children with biliary atresia (BA) complicated with acute necrosis (ALN) can be registered on the waiting list for liver transplantation (LT) in a special intermediate grade urgent code. Over a 7 years period, 100 children have been submitted to elective LT for BA and 15 to urgent LT. Urgent procedures accounted for 25% of LT for BA in patients aged 0-2 years and 67% (8/12) in patients under 1 year of age. Children actuarial survival at 1, 12 and 48 months was respectively 66%, 60% and 60% versus 92%, 86% and 85%, deaths occurring earlier in the urgent group. Graft actuarial survival at 1, 12 and 48 months were 60%, 53% and 53% versus 85%, 77% and 76% (p < 0.05), respectively. Outcome of children and grafts after LT is not significantly different in BA cases and in other urgent indications, excluding retransplantations. In a LT program based on cadaver organ donation, allocation of in an urgent registration code to children with BA and ALN offers them more than 50% chance to escape death and does not result in wasting of grafts.

摘要

根据法国尸体器官共享规则，患有胆道闭锁（BA）并伴有急性坏死（ALN）的儿童可以按照特殊的中级紧急代码登记在肝移植（LT）等待名单上。在7年的时间里，100名儿童接受了择期肝移植治疗BA，15名接受了紧急肝移植。紧急手术占0至2岁BA患者肝移植的25%，1岁以下患者中占67%（8/12）。紧急组儿童1个月、12个月和48个月的实际生存率分别为66%、60%和60%，而择期组分别为92%、86%和85%，紧急组死亡发生更早。移植肝1个月、12个月和48个月的实际生存率分别为60%、53%和53%，择期组分别为85%、77%和76%（p<0.05）。在不包括再次移植的情况下，BA病例和其他紧急指征的儿童肝移植后儿童及移植肝的结局无显著差异。在基于尸体器官捐赠的肝移植项目中，为患有BA和ALN的儿童分配紧急登记代码使他们有超过50%的机会逃脱死亡，且不会导致移植物浪费。