Woodle E S, Millis J M, So S K, McDiarmid S V, Busuttil R W, Esquivel C O, Whitington P F, Thistlethwaite J R
Department of Surgery, University of Chicago, Illinois 60637, USA.
Transplantation. 1998 Sep 15;66(5):606-9. doi: 10.1097/00007890-199809150-00010.
Pediatric liver transplant recipients have traditionally been grouped according to age. Age-based classification schemes are useful in identifying clinical problems in selected age groups and also for developing solutions to these problems. Although infants in the first 3 months of life have not traditionally been considered a distinct age group, several features of these infants may distinguish them from other pediatric liver transplant recipients.
The experience with liver transplantation in infants during the first 3 months of life in three large pediatric liver transplant programs (University of Chicago, Stanford University, and UCLA) was analyzed in order to characterize this group.
A total of 23 liver transplants were performed at these three centers in children younger than 3 months of age. This group of patients comprised approximately 37% of the U.S. experience between 1988 and 1994 according to United Network for Organ Sharing statistics. Age distribution at the time of transplantation included the following: <1 month, 28%; 1-2 months, 35%; and 2-3 months, 36%. Median age at the time of transplantation was 37 days (range, 7-90 days), and mean age was 57+/-30 days. Mean weight at the time of transplantation was 3.8+/-1.0 kg. Etiology of liver disease included idiopathic hepatitis, 52%; iron storage disease, 17%; and other causes, 31%. Types of liver allografts used included cadaveric, 85% (reduced size, 60%, and full-size, 25%); living donor, 15%; ABO-identical, 65%; and ABO-compatible, 35%. Actuarial patient and graft survival rates were 60% and 60% at 1 year and 60% and 42% at 2 years, respectively. Median follow-up was 1.5 years. Rejection occurred in 42% of patients, with a median time to first rejection of 13 days. Of these patients, 28% required steroids only and 14% required OKT3. Three patients (14%) were retransplanted at a median time to retransplantation of 1.6 years. Vascular thrombosis occurred in three patients (14%).
Liver transplantation performed in infants younger than 3 months of age (1) provides acceptable short- and long-term patient and graft survival, (2) is associated with significant rates of rejection, and (3) is not associated with excessive rates of vascular thrombosis. The etiology of end-stage liver disease occurring in the first 3 months of life is distinct from that in other pediatric liver transplant recipient age groups. These infants should be referred promptly for liver transplantation as reasonable survival can be expected.
小儿肝移植受者传统上是根据年龄进行分组的。基于年龄的分类方案有助于识别特定年龄组的临床问题，并为解决这些问题制定方案。尽管传统上未将出生后前3个月的婴儿视为一个独特的年龄组，但这些婴儿的一些特征可能使其有别于其他小儿肝移植受者。
分析了三个大型小儿肝移植项目（芝加哥大学、斯坦福大学和加州大学洛杉矶分校）中出生后前3个月婴儿的肝移植经验，以描述该组特征。
这三个中心共对3个月以下的儿童进行了23例肝移植。根据器官共享联合网络的统计数据，该组患者约占1988年至1994年美国肝移植经验的37%。移植时的年龄分布如下：<1个月，28%；1 - 2个月，35%；2 - 3个月，36%。移植时的中位年龄为37天（范围7 - 90天），平均年龄为57±30天。移植时的平均体重为3.8±1.0千克。肝病病因包括特发性肝炎，52%；铁储存疾病，17%；其他原因，31%。使用的肝同种异体移植物类型包括尸体供肝，85%（减体积供肝，60%，全尺寸供肝，25%）；活体供肝，15%；ABO血型相同，65%；ABO血型相容，35%。患者和移植物的精算生存率1年时分别为60%和60%，2年时分别为60%和42%。中位随访时间为1.5年。42%的患者发生排斥反应，首次排斥反应的中位时间为13天。在这些患者中，28%仅需使用类固醇，14%需使用OKT3。3例患者（14%）在中位再移植时间1.6年时接受了再次移植。3例患者（14%）发生血管血栓形成。
对3个月以下婴儿进行肝移植（1）可提供可接受的短期和长期患者及移植物生存率，（2）排斥反应发生率较高，（3）血管血栓形成发生率不过高。出生后前3个月发生的终末期肝病病因与其他小儿肝移植受者年龄组不同。这些婴儿应及时转诊进行肝移植，因为有望获得合理的生存率。
