婴儿肝移植的结果与大龄儿童患者的结果相当。
Infant pediatric liver transplantation results equal those for older pediatric patients.
作者信息
Van der Werf W J, D'Alessandro A M, Knechtle S J, Pilli G, Hoffmann R M, Judd R H, Odorico J S, Kirk A D, Rayhill S C, Sollinger H W, Kalayoglu M
机构信息
Department of Surgery, University of Wisconsin School of Medicine, Madison 53792-7375, USA.
出版信息
J Pediatr Surg. 1998 Jan;33(1):20-3. doi: 10.1016/s0022-3468(98)90353-0.
METHODS
From July 1984 to July 1995, 99 pediatric patients underwent 127 orthotopic liver transplants (OLT) at the University of Wisconsin Children's Hospital. The patients were divided into four groups according to age at time of transplant: group I, 0 to 6 months (n = 20); group II, 6 to 12 months (n = 18); group III, 1 to 2 years (n = 10); and group IV, 2 to 18 years (n = 51). A retrospective analysis was performed to compare these four groups with regard to preoperative indications and demographics, intraoperative technique, complications, and survival. All patients were followed up for 2 to 13 years.
RESULTS
Biliary atresia was the most common indication for OLT in all four groups. The average waiting period varied from 19+/-18 days for group I to 44+/-64 days for group IV. Reduced-size liver transplant (I, 41%; II, 52%; III, 28%; IV, 21%), split-liver transplant (I, 0%; II, 7.4%; III, 17%; IV, 2.9%), or whole-liver transplant techniques were used. Although postoperative Intensive Care Unit stay was longer for the 0- to 6-month-old patients (I, 20+/-64; II, 7.6+/-9; III, 13+/-17; IV, 6.8+/-14 days), the total hospital stay (I, 43+/-63; II, 33+/-34; III, 32+/-20; IV, 29+/-31 days) was similar for all patients. The incidence of hepatic artery thrombosis (I, 19%; II, 19%; III, 27%; IV, 16%), biliary tract complications (I, 4.8%; II, 15%; III, 20%; IV, 14%), and retransplantation (I, 9.5%; II, 41%; III, 33%; IV, 14%) were not significantly different between the four groups. Portal vein thrombosis (I, 9.5%; II, 11%; III, 6.6; IV, 0%) and primary nonfunction (I, 9.5%; II, 7.4%; III, 0%; IV, 3.1%) occurred more frequently in the 0- to 6-month and 6- to 12-month groups, however, the 1-, 5-, and 10-year survival rate for patients (I, 85%, 79%, 79%; II, 89%, 74%, 74%; III, 80%, 80%, 80%; IV, 84%, 75%, 75%, respectively) and primary liver allografts (I, 69%, 69%, 69%; II, 72%, 72%, 63%; III, 70%, 70%, 70%; IV, 71%, 57%, 57%, respectively) were not significantly different (P = .98 and P = .83).
CONCLUSION
These results demonstrate that OLT can be effectively performed on infants of all ages and that OLT should not be delayed because of age.
方法
1984年7月至1995年7月，99例儿科患者在威斯康星大学儿童医院接受了127例原位肝移植（OLT）。根据移植时的年龄将患者分为四组：第一组，0至6个月（n = 20）；第二组，6至12个月（n = 18）；第三组，1至2岁（n = 10）；第四组，2至18岁（n = 51）。进行回顾性分析以比较这四组患者在术前适应证、人口统计学、术中技术、并发症和生存率方面的情况。所有患者均随访2至13年。
结果
在所有四组中，胆道闭锁是OLT最常见的适应证。平均等待时间从第一组的19±18天到第四组的44±64天不等。采用了减体积肝移植（第一组，41%；第二组，52%；第三组，28%；第四组，21%）、劈离式肝移植（第一组，0%；第二组，7.4%；第三组，17%；第四组，2.9%）或全肝移植技术。尽管0至6个月大的患者术后在重症监护病房的停留时间更长（第一组，20±64天；第二组，7.6±9天；第三组，13±17天；第四组，6.8±14天），但所有患者的总住院时间（第一组，43±63天；第二组，33±34天；第三组，32±20天；第四组，29±31天）相似。四组之间肝动脉血栓形成（第一组，19%；第二组，19%；第三组，27%；第四组，16%）、胆道并发症（第一组，4.8%；第二组，15%；第三组，20%；第四组，14%）和再次移植（第一组，9.5%；第二组，41%；第三组，33%；第四组，14%）的发生率无显著差异。门静脉血栓形成（第一组，9.5%；第二组，11%；第三组，6.6%；第四组，0%）和原发性无功能（第一组，9.5%；第二组，7.4%；第三组，0%；第四组，3.1%）在0至6个月和6至12个月组中更频繁发生，然而，患者的1年、5年和10年生存率（第一组分别为85%、79%、79%；第二组分别为89%、74%、74%；第三组分别为80%、80%、80%；第四组分别为84%、75%、75%）和原发性肝移植存活率（第一组分别为69%、69%、69%；第二组分别为72%、72%、63%；第三组分别为70%、70%、70%；第四组分别为71%、57%、57%）无显著差异（P = 0.98和P = 0.83）。
结论
这些结果表明，OLT可有效地应用于所有年龄段的婴儿，且OLT不应因年龄而延迟。
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