Improved Outcomes in Liver Transplantation in Children With Acute Liver Failure
Improved Outcomes in Liver Transplantation in Children With Acute Liver Failure
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DOI：
10.1097/mpg.0b013e3182a80362
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发表时间：
2014-01-01
影响因子：
2.9
通讯作者：
Lee, Sung-Gyu
中科院分区：
文献类型：
--
作者：
Oh, Seak Hee;Kim, Kyung Mo;Lee, Sung-Gyu
目的：本研究的目的是回顾以活体供体为主的急性肝衰竭（ALF）儿童移植计划的经验。方法：数据来源于韩国一家主要肝脏中心的 50 名 ALF 儿童的回顾性图表审查。结果：共有 50 名 ALF 儿童接受了 47 例（94%）原发性活体肝移植和 3 例（6%）尸体肝移植。移植物1年和5年的累积存活率分别为81.9%和79.2%。总体再移植率为12%。这些患者的1年和5年累积生存率均为87.9%。大多数死亡事件是由于前一次移植失败所致。我们没有观察到捐献者死亡。根据多变量分析，移植前血小板减少症或术前必须使用分子吸附剂回收系统的儿童与移植物丢失有关。年龄小于 2 岁和肝性脑病超急性发作（7 天内）与移植前血小板减少症相关。结论：本研究中以活体供体为主的移植计划在受者和供者的临床结果方面表现出可容忍的成就；然而，移植前血小板减少等推定因素在移植后不良预后中的作用似乎尚不清楚。
Objective:The aim of our study was to review the experiences of a living donor-dominant transplantation program for children with acute liver failure (ALF).Methods:Data were derived from the retrospective chart review of 50 children with ALF in a major liver center in the Republic of Korea.Results:A total of 50 children with ALF underwent 47 (94%) primary living donor liver transplantations and 3 (6%) cadaveric liver transplantations. The cumulative survival rates of the grafts at 1 and 5 years were 81.9% and 79.2%, respectively. The overall retransplantation rate was 12%. The cumulative survival rates of these patients at 1 and 5 years were all 87.9%. Most incidents of mortality followed the failure of the preceding graft. We observed no mortalities among donors. Based on multivariate analysis, children who had pretransplant thrombocytopenia or had to use the molecular adsorbent recycling system preoperatively were related to the graft loss. Age younger than 2 years and a hyperacute onset (within 7 days) of hepatic encephalopathy were associated with pretransplant thrombocytopenia.Conclusions:Living donor-dominant transplantation program in the present study demonstrates tolerable achievements in terms of clinical outcomes of recipients and donors; however, putative factors, such as pretransplant thrombocytopenia, seem to play unclear roles in a poor prognosis following transplantation.