急性和慢性肝移植排斥反应的移植结果。

Results of transplantation for acute and chronic hepatic allograft rejection.

作者信息

Nicolette L A, Reichard K W, Falkenstein K, Pierson A, Dunn S P

机构信息

St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.

出版信息

J Pediatr Surg. 1998 Jun;33(6):909-12. doi: 10.1016/s0022-3468(98)90672-8.

DOI:10.1016/s0022-3468(98)90672-8

PMID:9660227

Abstract

BACKGROUND/PURPOSE: Transplantation for rejection is a requirement in liver transplant recipients when allograft failure is imminent. The authors evaluated the outcome of these children and their allografts.

METHODS

The medical records of 129 children who received a liver transplant were reviewed retrospectively. Twelve children required transplantation for biopsy-proven rejection--10 chronic and two acute. Overall patient and graft survival were compared with children receiving primary liver transplants. The current allograft function of the patients undergoing transplants was also reviewed. Statistical significance was determined by Fisher's Exact test.

RESULTS

Twelve children received at least one retransplant for biopsy-proven rejection. Graft survival at 1 year was 58% (v 79% for primary transplants) and patient survival was 83% (vs 89%). Two allografts were lost because of primary allograft nonfunction. Three additional allografts were lost-two to recurrent rejection and one to hepatic artery thrombosis. Two patients who lost a second transplant to rejection required a total of seven transplants to treat rejection. Two children died, one of primary nonfunction and one of adenovirus pneumonia. The 10 surviving patients all have excellent graft function (total bilirubin, 0.74 +/- 0.38, aspartate aminotransferase, 40 +/- 22).

CONCLUSION

These data suggest that transplantation for rejection can be accomplished safely with a patient survival rate comparable to primary liver transplantation; however, graft loss is excessive and underscores the need for more adequate immunosuppression.

摘要

背景/目的：当同种异体肝移植即将失败时，因排斥反应进行再次移植是肝移植受者的一项需求。作者评估了这些儿童及其移植物的结局。

方法

回顾性分析了129例接受肝移植儿童的病历。12例儿童因活检证实的排斥反应需要再次移植——10例为慢性排斥反应，2例为急性排斥反应。将患者和移植物的总体生存率与接受初次肝移植的儿童进行比较。还对接受再次移植患者目前的移植物功能进行了评估。采用Fisher精确检验确定统计学意义。

结果

12例儿童因活检证实的排斥反应至少接受了一次再次移植。1年时移植物生存率为58%（初次移植为79%），患者生存率为83%（初次移植为89%）。2例移植物因原发性移植物无功能而丢失。另外3例移植物丢失——2例因反复排斥反应，1例因肝动脉血栓形成。2例因排斥反应失去第二次移植的患者共需要7次移植来治疗排斥反应。2例儿童死亡，1例死于原发性无功能，1例死于腺病毒肺炎。10例存活患者的移植物功能均良好（总胆红素，0.74±0.38；天冬氨酸转氨酶，40±22）。