Is there still a need for living-related liver transplantation in children?
Is there still a need for living-related liver transplantation in children?
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DOI：
10.1097/00000658-200112000-00002
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发表时间：
2001-12-01
影响因子：
9
通讯作者：
Rogiers, X
中科院分区：
文献类型：
--
作者：
Broering, DC;Mueller, L;Rogiers, X
目的评价和比较分离式肝移植(SLT)和活体亲缘肝移植(LRT)的价值。SLT的进一步发展，即原位劈裂技术，是在LRT的基础上发展起来的，它本身就标志着在术后移植物功能和存活率方面的优化结果。SLT和LRT的结合消除了等待名单上的死亡，从而提出了是否仍然需要活体供肝移植的问题。方法对1996年4月至2000年12月间施行的43例原发LRT患者和49例已知移植物重量的原发SLT患者(异位14例，原位35例)的预后和术后肝功能进行比较。结果中位随访35个月后，淤泥组患者实际生存率为82%，LRT组为88%。实际移植物存活率分别为76%和81%。SLT组原发无功能发生率为12%，LRT组为2.3%。肝功能参数(凝血酶原时间、凝血因子V、胆红素清除)和手术并发症发生率无显著差异。SLT组平均冷缺血时间长于LRT组。SLT组术后第一周血清丙氨酸氨基转移酶水平明显高于对照组。LRT组移植物有脂肪变性征象多于SLT组。结论LRT和SLT术后近期和远期疗效无明显差异。为了避免供体在LRT中的风险，在有身体器官的国家，SLT是儿科肝移植的一线治疗方法。LRT为不能及时找到身体移植物的紧急病例提供了一种解决方案，或者如果选择最佳移植时间点至关重要。
Objective To assess and compare the value of split-liver transplantation (SLT) and living-related liver transplantation (LRT).Summary Background Data The concept of SLT results from the development of reduced-size transplantation. A further development of SLT, the in situ split technique, is derived from LRT, which itself marks the optimized outcome in terms of postoperative graft function and survival. The combination of SLT and LRT has abolished deaths on the waiting list, thus raising the question whether living donor liver transplantation is still necessary.Methods Outcomes and postoperative liver function of 43 primary LRT patients were compared with those of 49 primary SLT patients (14 ex situ, 35 in situ) with known graft weight performed between April 1996 and December 2000. Survival rates were analyzed using the Kaplan-Meier method.Results After a median follow-up of 35 months, actual patient survival rates were 82% in the SILT group and 88% in the LRT group. Actual graft survival rates were 76% and 81%, respectively. The incidence of primary nonfunction was 12% in the SLT group and 2.3% in the LRT group. Liver function parameters (prothrombin time, factor V, bilirubin clearance) and surgical complication rates did not differ significantly. In the SLT group, mean cold ischemic time was longer than in the LRT group. Serum values of alanine aminotransferase during the first postoperative week were significantly higher in the SLT group. In the LRT group, there were more grafts with signs of fatty degeneration than in the SLT group.Conclusions The short- and long-term outcomes after LRT and SLT did not differ significantly. To avoid the risk for the donor in LRT, SLT represents the first-line therapy in pediatric liver transplantation in countries where cadaveric organs are available. LRT provides a solution for urgent cases in which a cadaveric graft cannot be found in time or if the choice of the optimal time point for transplantation is vital.