Auxiliary Liver Transplantation for Acute Liver Failure in Children
Auxiliary Liver Transplantation for Acute Liver Failure in Children
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DOI：
10.1097/sla.0b013e3181bdfef6
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发表时间：
2010-02-01
影响因子：
9
通讯作者：
Rela, Mohamed
中科院分区：
文献类型：
--
作者：
Faraj, Walid;Dar, Faisal;Rela, Mohamed
目的：总结19年来辅助性肝移植治疗儿童急性肝功能衰竭(ALF)的最大经验。方法：1990~2009年间，共施行128例儿童ALF肝移植。其中20例接受辅助性肝移植(19例身体肝，1例活肝)。受者年龄中位数为12岁(范围：1-16岁)。辅助性部分原位肝移植适应证为血清阴性非甲非乙型肝炎16例，药物中毒2例，自身免疫性肝炎1例，蘑菇中毒1例。移植等待时间中位数为2天(1~9天)。自体肝部分切除后，原位移植20例，其中右叶8例，左叶8例，左叶3例，全肝1例。通过放射学、核医学成像和组织学对肝再生进行评估。每隔3~6个月和每年进行一次随访成像和活检。结果：患者1、5和10年的存活率为85%。移植后中位时间为9天(范围：8-52天)有3例死亡。移植后15个月因慢性排斥再次移植。无胆道或血管并发症。在17名幸存者中，14名(821%)成功地再生了他们的自体肝脏，到目前为止，I级儿童(65%)在移植后平均23个月(范围4-106)退出了免疫抑制。结论：符合肝移植标准的ALF患儿应考虑辅助性部分原位肝移植。
Objective: The aim of this study is to present the largest experience of auxiliary liver transplantation for acute liver failure (ALF) in children over the past 19 years.Methods: Between 1990 and 2009, it total of 128 liver transplants were performed on children with ALF. Of these, 20 received auxiliary liver transplants (19 were cadaveric and 1 living graft). The recipient median age was 12 years (range: 1-16). Indications for auxiliary Partial orthotopic liver transplantation were seronegative non-A non-B hepatitis in 16 children, drug induced in 2, and I autoimmune hepatitis and I mushroom poisoning. The median waiting time for transplantation was 2 days (range: 1-9). After native liver partial hepatectomy, 20 grafts were implanted orthotopically and included 8 right lobes, 8 left lateral segments, 3 left lobes, and I whole liver. Regeneration of the native liver was assessed by radiologic, nuclear medicine imaging, and histology. Follow-up imaging and biopsies were performed at intervals of 3 to 6 months and yearly.Results: Patient survival was 85% at 1, 5, and 10 years. There were 3 deaths at a median of 9 days (range: 8-52) post-transplantation. There was I retransplant for chronic rejection 15 months post-transplantation. There were no biliary or vascular complications. Of 17 survivors, 14 (821%) have Successfully regenerated their native liver and so far I I children (65% of the survivors) have been withdrawn from immunosuppression at a median time of 23 months (range: 4-106) after transplantation.Conclusion: Auxiliary partial orthotopic liver transplantation should be considered in children presenting with ALF who fulfill criteria for liver transplantation.