Impact of graft type on outcome in pediatric liver transplantation - A report from Studies of Pediatric Liver Transplantation (SPLIT)
Impact of graft type on outcome in pediatric liver transplantation - A report from Studies of Pediatric Liver Transplantation (SPLIT)
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DOI：
10.1097/sla.0b013e3180caa415
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发表时间：
2007-08-01
影响因子：
9
通讯作者：
Song, Changhong
中科院分区：
文献类型：
--
作者：
Diamond, Ivan R.;Fecteau, Annie;Song, Changhong
目的：检查技术变异型肝移植技术相对于儿科肝移植受者全器官肝移植的结果。背景：技术变异型肝移植技术包括分割肝移植、减缩肝移植和活体供体肝移植，其发展是为了满足儿科受者对及时且大小合适的移植物的需求。方法：分析儿科肝移植研究 (SPLIT) 登记处的数据，该数据库是 44 个北美儿科肝移植项目的多中心数据库。将每种技术变体的结果（发病率和死亡率）与整个器官受者的结果进行比较。结果：可获得 2192 名移植受者的数据（1183 名完整器官、261 名分割器官、388 名缩小器官和 360 名活体供体）。所有技术变异移植类型的接受者都比整个器官接受者年轻得多，但平均在等待名单上花费的时间少 2.3 个月。相对于整个器官，每种技术变体的移植后 30 天发病率均有所增加（完整器官占 45.1%，分割器官占 66.7%，减少器官占 65.5%，活体器官移植占 51.9%）。在所有技术变异类型中，胆道并发症（30天：7.5%整体、18.8%分割、16%减少、17.5%活体供体）和门静脉血栓（30天：3.6%整体、8%分割、8%减少、7.5%活体供体）更常见。在多变量分析中，移植物类型是移植物丢失（死亡或再移植）的独立预测因素。与整个器官受者相比，分割和缩小（相对风险分别为 1.74 和 1.77）移植物的结果较差。结论：技术变异技术扩大了儿科供体库并缩短了从上市到移植的时间，但它们与发病率和死亡率增加有关。
Objective: To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients.Background: Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need for timely and size appropriate grafts for pediatric recipients.Methods: Analysis of data from the Studies of Pediatric Liver Transplantation (SPLIT) registry, a multicenter database of 44 North American pediatric liver transplant programs. The outcome (morbidity and mortality) of each of the technical variants were compared with that of whole organ recipients.Results: Data were available on 2192 transplant recipients (1183 whole, 261 split, 388 reduced, and 360 live donor). Recipients of all technical variant graft type were significantly younger than whole organ recipients, but on average spent 2.3 months less on the waiting list. Thirty-day post-transplant morbidity was increased for each type of technical variant relative to whole organ (45.1% whole, 66.7% split, 65.5% reduced, 51.9% live-donor). Biliary complications (30 day: 7.5% whole, 18.8% split, 16% reduced, 17.5% live-donor) and portal vein thrombosis (30 day: 3.6% whole, 8% split, 8% reduced, 7.5% live-donor) were more common in all technical variant types. Graft type was an independent predictor of graft loss (death or retransplantation) in a multivariate analysis. Split and reduced (relative risk = 1.74 and 1.77, respectively) grafts had a worse outcome when compared with whole organ recipients.Conclusions: Technical variant techniques expand the pediatric donor pool and reduce time from listing to transplant, but they are associated with increased morbidity and mortality.