Liver transplantation following the Kasai procedure in treatment of biliary atresia: a single institution analysis.
Liver transplantation following the Kasai procedure in treatment of biliary atresia: a single institution analysis.
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Kasai 手术后的肝移植治疗胆道闭锁：单一机构分析。
DOI：
10.1007/s00383-014-3552-4
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Nio M.
中科院分区：
文献类型：
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作者：
Sasaki H;Tanaka H;Wada M;Kazama T;Nishi K;Nakamura M;Kudo H;Kawagishi N;Nio M.
目的评价肝移植治疗胆道闭锁的疗效。方法1955年1月至2013年12月，东北大学附属医院采用Kasai手术治疗胆道闭锁患者358例，其中(17.9%)行肝移植。将这些患者按移植时年龄分为4组：1组，2岁，2岁；2组，2~9岁，16例；3组，10~19岁，11例；4组，≥20岁，10例。结果活体供体(n=57)和已故供体(n=7)均行LTX。指征为不可逆性黄疸53例，顽固性胆管炎3例，肝肺综合征6例，门静脉高压症1例，肠出血1例。1组和2组的黄疸发生率高于3组和4组(p=0.031)。第1、2、3、4组的存活率分别为81.5%、100%、90.9%和80%。结论虽然LTX的总体存活率令人满意，但部分成人受者遇到了LTX相关的困难。密切的随访，对身体和社会状况的细致评估，多学科支持系统的存在，以及LTX的适当时间疗程，都是BA治疗的基本因素。
PurposeThis study aimed to assess outcomes of liver transplantation (LTx) in patients with biliary atresia (BA).MethodsThe Kasai procedure was performed for 358 patients at Tohoku University Hospital between January 1955 and December 2013; 64 (17.9 %) required LTx. These 64 patients were divided into 4 groups according to their age at the time of transplantation: Group 1, aged <2 years (n= 27); Group 2, aged 2–9 years (n= 16); Group 3, aged 10–19 years (n= 11); and Group 4, aged ≥20 years (n= 10). Clinical parameters were evaluated retrospectively.ResultsBoth living-donor (n= 57) and deceased-donor (n= 7) LTx were performed. Indications were irreversible jaundice (n= 53), intractable cholangitis (n= 3), hepatopulmonary syndrome (n= 6), portopulmonary hypertension (n= 1), and intestinal bleeding (n= 1). Jaundice occurred more frequently in Groups 1 and 2 than in Groups 3 and 4 (p= 0.031). Survival rates were 81.5, 100, 90.9, and 80 % in Groups 1, 2, 3, and 4, respectively.ConclusionAlthough the overall LTx survival rate was satisfactory, some adult recipients experienced LTx-related difficulty. Close follow-up, meticulous assessment of physical and social conditions, presence of a multidisciplinary support system, and appropriate time course for LTx are all essential factors in the treatment of BA.