Improved outcomes in pediatric liver transplantation for acute liver failure
Improved outcomes in pediatric liver transplantation for acute liver failure
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DOI：
10.1111/j.1399-3046.2010.01356.x
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发表时间：
2010-11-01
影响因子：
1.3
通讯作者：
Iyer, Kishore
中科院分区：
文献类型：
--
作者：
Miloh, Tamir;Kerkar, Nanda;Iyer, Kishore
奥尔特是ALF的救命选择。目的：评价我们在儿童奥尔特治疗ALF的结果。方法：回顾性分析1992年至2007年的数据。结果如下：在142名ALF儿童中，126名被列出，其中40名自发改善，9名死亡，77名接受奥尔特（平均等待时间为4天）。53名儿童接受了死亡供体移植物（34例完整移植物和19例劈裂移植物），有24例活体供体移植物。1年和5年患者存活率分别为87%和80%，移植物存活率分别为83%和79%。13例患者在奥尔特后死亡，7例患者中有9例再次移植。患者体重、住院时间、肌酐和感染与死亡显著相关;单变量分析显示体重增加和黑人种族与移植物丢失相关，但多变量分析显示无关。两组患者的生存率（1年和5年）、移植物丢失或其他并发症无显著差异。结论：我们报告了最大的单中心奥尔特治疗小儿ALF的研究，证明不同移植物类型之间的结局没有差异。我们对节段性移植物的广泛使用可以使这一高危人群更早地进行原位肝奥尔特，并有助于我们获得良好的结局。
OLT is a life-saving option for ALF. Aim: To evaluate our outcomes in pediatric OLT for ALF. Methods: Retrospective review of our data between 1992 and 2007. Results: Of 142 children with ALF, 126 were listed, of which 40 spontaneously improved, nine died, and 77 underwent OLT (median waiting time four days). Fifty-three children received deceased donor grafts (34 whole and 19 split grafts), and there were 24 living donor grafts. The one- and five-yr patient survival was 87% and 80%, and graft survival 83% and 79%, respectively. Thirteen patients died after OLT, and there were nine retransplants in seven patients. Patient weight, length of stay, creatinine, and infection were significantly associated with death; increased weight and black ethnicity were associated with graft loss on univariate analysis, but not on multivariate analysis. There were no significant differences in patient survival (one and five yr), graft loss, or other complications between the groups. Conclusion: We report the largest single-center study of OLT in pediatric ALF, demonstrating no difference in outcomes between different graft types. Our liberal use of segmental grafts may allow earlier OLT in this high-risk cohort and contribute to our excellent outcomes.