Alonso M H, Ryckman F C
Liver Transplant Services, Children's Hospital Medical Center, University of Cincinnati, Ohio 45229, USA.
Semin Liver Dis. 1998;18(3):295-307. doi: 10.1055/s-2007-1007165.
Orthotopic liver transplantation has significantly improved the survival rate of children with end-stage liver disease. Efforts to correct abnormalities existing prior to transplantation coupled with improved surgical techniques and immunosuppression have led to better quality of life and 1-year survival rates approaching 90% in many centers. Despite this success the expanding waiting list population of all ages has driven development of operative techniques to expand the donor pool. Building on the success of reduced-size transplantation, split-liver and living-donor transplantation are now suitable alternatives, especially when used in candidates with satisfactory clinical stability. In the post-operative period, infectious complications represent an important cause of morbidity and mortality. Although antimicrobial regimens are effective in the immediate post-operative phase, acquisition of viral infections represents a major concern particularly in the young liver recipient. Early detection and development of new anti-viral agents are likely to decrease occurrence of post-transplant proliferative disorders and optimize longterm transplantation outcome.
原位肝移植显著提高了终末期肝病患儿的存活率。移植前纠正现存异常的努力，加上手术技术和免疫抑制的改进，使得生活质量得到改善，在许多中心1年存活率接近90%。尽管取得了这一成功，但各年龄段不断扩大的等待名单人群推动了手术技术的发展，以扩大供体库。在减体积肝移植成功的基础上，劈离式肝移植和活体供肝移植现在是合适的替代方法，特别是用于临床稳定性良好的候选者时。在术后阶段，感染性并发症是发病和死亡的重要原因。尽管抗菌方案在术后即刻有效，但获得病毒感染是一个主要问题，特别是在年轻的肝移植受者中。新抗病毒药物的早期发现和开发可能会减少移植后增殖性疾病的发生，并优化长期移植结果。
