Influence of graft type on outcomes after pediatric liver transplantation
Influence of graft type on outcomes after pediatric liver transplantation
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DOI：
10.1111/j.1600-6143.2004.00359.x
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发表时间：
2004-03-01
影响因子：
8.8
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Roberts, JP;Hulbert-Shearon, TE;Port, FK
我们试图确定哪种类型的供体移植物在肝移植后为儿童和年轻人提供最好的结果。利用美国科学注册中心的移植受者数据库，我们确定了1989-2000年间首例肝移植受者6467名，年龄30岁。我们使用COX模型检验了按年龄(2，2-10，11-16，17-29)和供者类型(已故供者全身型(DD-F)，分体型(DD-S)，活体(LD))调整后的患者和移植结果。0.0001)和DD-F(RR=0.7，p=0.02)，且在移植后第一年死亡率低于DD-S(RR=0.71，p=0.08)。相反，年龄较大的儿童表现出更高的移植物丢失风险和与LD移植相关的更高死亡率的趋势。在年轻人中，DD-S移植与不良预后相关。三年的随访结果相似，但不同年龄组内不同移植物类型的死亡风险没有显著差异。对于2岁的受者，LD移植的移植物存活率高于DD-F或DD-S，并倾向于比DD-S更好的患者存活率。在最常见的接受肝移植的儿童年龄组(<；2年)，活体供体是首选的供体来源。
We sought to determine which type of donor graft provides children and young adults with the best outcomes following liver transplantation. Using the US Scientific Registry of Transplant Recipients database, we identified 6467 recipients of first liver transplants during 1989-2000 aged < 30 years. We used Cox models to examine adjusted patient and graft outcomes by age ( < 2, 2-10, 11-16, 17-29) and donor graft type (deceased donor full size (DD-F), split (DD-S), living donor (LD)].For patients aged < 2, LD grafts had a significantly lower risk of graft failure than DD-S (RR = 0.49, p < 0.0001) and DD- F (RR = 0.70, p = 0.02) and lower mortality risk than DD- S (RR = 0.71, p = 0.08) during the first year post-transplant. In contrast, older children exhibited a higher risk of graft loss and a trend toward higher mortality associated with LD transplants. In young adults, DD- S transplants were associated with poor outcomes. Three-year follow up yielded similar graft survival results but no significant differences in mortality risk by graft type within age group.For recipients aged < 2, LD transplants provide superior graft survival than DD- F or DD- S and trend toward better patient survival than DD- S. Living donor is the preferred donor source in the most common pediatric age group ( < 2 years) undergoing liver transplantation.