Pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of mortality
Pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of mortality
复制标题
上海小儿活体肝移植十年进展：死亡特点及危险因素
DOI：
10.3748/wjg.v26.i12.1352
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发表时间：
2020-03-28
影响因子：
4.3
通讯作者：
Su, Dian-San
中科院分区：
文献类型：
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作者：
Pan, Zhi-Ying;Fan, Yi-Chen;Su, Dian-San
### 背景
儿童活体肝移植（LDLT）已成为终末期肝病患者的金标准治疗方法。随着器官保存、免疫抑制、手术及麻醉技术的进步，全球范围内接受LDLT的患者生存率及长期预后均有显著改善。然而，中国关于儿童LDLT麻醉管理及术后生存率的数据较为匮乏。
### 目的
回顾上海地区儿童LDLT的现状，探究儿童LDLT麻醉管理及生存率的相关影响因素。
### 方法
我们开展了一项回顾性观察研究，通过查阅2006年10月21日首例手术至2016年8月10日在仁济医院和华山医院接受儿童LDLT的544例患者的病历记录，调查上海地区儿童LDLT的现状。
### 结果
患者30天、90天、1年及2年生存率分别为95.22%、93.38%、91.36%和89.34%。2011年1月1日之后的2年患者生存率较之前显著提高（74.47% 对比 90.74%；风险比：2.92；95%置信区间（CI）：2.16 - 14.14；P = 0.0004）。重症监护病房（ICU）内机械通气的中位时长为18小时[四分位间距（IQR），15.25 - 20.25]，ICU中位住院时间为6天（IQR：4.80 - 9.00），术后中位住院时间为24天（IQR：18.00 - 34.00）。544例患者中有47例（8.60%）术中未接受红细胞输注。
### 结论
儿童终末期肝病（PELD）评分、麻醉时长、手术时长、术中失血量及ICU住院时间是患者院内生存的独立预测因素。儿童终末期肝病评分、手术时长及ICU住院时间是患者1年及3年生存的独立预测因素。
BACKGROUND Pediatric living donor liver transplantation (LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare. AIM To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT. METHODS We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital. RESULTS The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%, and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period (74.47% vs 90.74%; hazard ratio: 2.92; 95% confidence interval (CI): 2.16–14.14; P = 0.0004). Median duration of mechanical ventilation in the intensive care unit (ICU) was 18 h [interquartile range (IQR), 15.25–20.25], median ICU length of stay was 6 d (IQR: 4.80–9.00), and median postoperative length of stay was 24 d (IQR: 18.00–34.00). Forty-seven (8.60%) of 544 patients did not receive red blood cell transfusion during the operation. CONCLUSION Pediatric end-stage liver disease (PELD) score, anesthesia duration, operation duration, intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score, operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.