Early vascular complications after pediatric liver transplantation
Early vascular complications after pediatric liver transplantation
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DOI：
10.1053/lv.2000.6146
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发表时间：
2000-05-01
影响因子：
4.6
通讯作者：
Slooff, MJH
中科院分区：
文献类型：
--
作者：
Sieders, E;Peeters, PMJG;Slooff, MJH
血管并发症对肝移植术后的预后有不利影响。大多数研究只关注肝动脉血栓形成（HAT），本研究分析了157例儿童肝移植中HAT、门静脉血栓形成（PVT）和静脉流出道梗阻（VOTO）的发生率、后果和危险因素。血管并发症的总发生率为21%。HAT、PVT和VOTO的发生率分别为10%、4%和6%。与无血管并发症的移植物相比，PVT和VOTO后的患者生存率以及HAT和PVT后的移植物生存率较低。为了确定血管并发症的危险因素，我们分析了与受体、供体和手术技术相关的因素。供体-受体（D/R）年龄比低、手术时间长、使用受体肝固有动脉进行动脉重建是发生HAT的危险因素。年龄小、体重轻、节段性移植物和背驮式技术是PVT暴发性肝衰竭的危险因素，高D/R年龄和体重比以及使用节段性移植物与VOTO有关。血管并发症发生率为21%的儿童肝移植，对患者和移植物的生存有重要影响。供体和受体之间的大小差异是发生血管并发症的重要危险因素，尤其是在节段性移植物移植中。通过避免已知的危险因素，患者和移植物的存活率可能会提高。
Vascular complications have a detrimental effect on the outcome after liver transplantation. Most studies focus exclusively on hepatic artery thrombosis (HAT), The current study analyzed the incidence, consequences, and risk factors for HAT, portal vein thrombosis (PVT), and venous outflow tract obstruction (VOTO) in a consecutive series of 157 pediatric liver transplantations. The overall incidence of vascular complications was 21%. The incidences of HAT, PVT, and VOTO were 10%, 4%, and 6%, respectively. Patient survival after PVT and VOTO and graft survival after HAT and PVT were less compared with survival of grafts without vascular complications. To identify risk factors for vascular complications, factors related to recipient, donor, and surgical techniques were analyzed. A low donor-recipient (D/R) age ratio, long surgical time, and use of the proper hepatic artery of the recipient for arterial reconstruction were risk factors for HAT. Young age, low weight, segmental grafts, and piggyback technique were risk factors for PVT Fulminant hepatic failure, high D/R age and weight ratios, and use of segmental grafts were related to VOTO. Vascular complications, which occurred in 21% of the pediatric liver transplantations, had a significant impact on patient and graft survival. Size disparity between donor and recipient was an important risk factor for vascular complications, especially in the case of transplantation of segmental grafts. Patient and graft survival might improve by avoiding the identified risk factors.