HEPATIC ARTERY THROMBOSIS IN INFANTS A COMPARISON OF WHOLE LIVERS, REDUCED‐SIZE GRAFTS, AND GRAFTS FROM LIVING‐RELATED DONORS 1
HEPATIC ARTERY THROMBOSIS IN INFANTS A COMPARISON OF WHOLE LIVERS, REDUCED‐SIZE GRAFTS, AND GRAFTS FROM LIVING‐RELATED DONORS 1
复制标题
婴儿肝动脉血栓形成全肝、缩小尺寸移植物和来自生前相关供体的移植物的比较 1
作者：
L. Stevens;J. Emond;J. Piper;T. Heffron;J. Thistlethwaite;P. Whitington;C. Broelsch
肝动脉血栓形成(HAT)是儿科肝移植(OLT)患者并发症和移植物丢失的主要原因。虽然一些移植物可以通过动脉血栓切除和重建来挽救，但许多患者需要再次移植。HAT降低了患者的存活率。有人建议，HAT的发生率可以通过使用缩小尺寸的移植物(RSG)来改变。我们分析了一系列接受原位肝移植的婴儿，以确定HAT在全尺寸原位肝移植、身体RSG和活体相关RSG中的频率。并探讨了动脉吻合技术在HAT发生发展中的作用。自1984年10月1日至1990年12月7日，共进行了433例肝移植。在此期间，100名3个月至2岁(平均13个月)的患者接受了134次肝移植。移植时的平均体重为7.9公斤。(范围：1.9-15公斤)。在134个移植物中，60个是全肝，61个是身体的RSG，13个是活体的RSG。其中右叶移植物9例，左叶移植物21例，左外叶移植物31例。27个身体RSG来自分裂的肝脏，而其他34个是简单的减少。13例活体相关RGS均为左侧节段。HAT发生率为25%(15/60)全肝，9/61例身体肝移植(15%)，3/13(23%)活体供肝肝移植(P=NS)。对身体RSG的细分显示，HAT发生在9例右叶移植物中的3例(33%)，21例左叶移植物中的3例(14%)，31例左侧段移植物中的3例(10%)(P=NS)。受体动脉吻合部位与HAT发生率相关(肝动脉21/86[24%]，腹主动脉1/9[11%]，主动脉2/32[6%]，P=0.06)。总之，在2岁以下的肝移植受者中，使用身体左叶或左外侧叶移植物和主动脉吻合术似乎可以降低肝动脉血栓形成的风险。
Hepatic artery thrombosis (HAT) is a major cause of patient morbidity and graft loss in pediatric liver transplantation (OLT). Although some grafts may be salvaged by arterial thrombectomy and reconstruction, many patients require retransplantation. Patient survival is reduced by HAT. It has been suggested that the incidence of HAT may be altered by the use of reduced-size grafts (RSG). We analyzed our series of infants receiving OLT to determine the frequency of HAT in full-size OLT, cadaveric RSG, and living-related RSG. The role of arterial anastomotic technique in the development of HAT was also examined. Between 10/1/84 and 12/7/90 433 liver transplants were performed. During this period 100 patients between 3 months and 2 years of age (mean 13 months) received 134 liver grafts. The mean weight at the time of transplant was 7.9 kg. (range: 1.9-15 kg). Of the 134 grafts, 60 were whole livers, 61 were cadaveric RSGs, and 13 were living-related RSGs. The cadaveric RSGs were 9 right lobe grafts, 21 left lobe grafts, and 31 left lateral segment grafts. Twenty-seven of the cadaveric RSGs were from split livers, while the other 34 were simple reductions. All 13 living-related RSGs were left lateral segments. HAT occurred in 15 of 60 (25%) whole livers, 9 of 61 (15%) cadaveric RSGs, and 3 of 13 (23%) of the living-related-donor RSGs (P = NS). Subdividing the cadaveric RSGs revealed that HAT occurred in 3 of 9 (33%) right lobe grafts, 3 of 21 (14%) left lobe grafts, and 3 of 31 (10%) left lateral segment grafts (P = NS). The site of the arterial anastomosis in the recipient correlated with the incidence of HAT (hepatic artery 21/86 [24%], celiac axis 1/9 [11%], aorta 2/32 [6%], P = 0.06). In conclusion, it appears that use of a cadaveric left lobe or left lateral segment graft and an aortic arterial anastomosis reduces the risk of hepatic artery thrombosis in liver transplant recipients less than 2 years of age.