Long-term outcome of pediatric liver transplantation for biliary atresia: A 10-year follow-up in a single center
Long-term outcome of pediatric liver transplantation for biliary atresia: A 10-year follow-up in a single center
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DOI：
10.1002/lt.20358
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发表时间：
2005-02-01
影响因子：
4.6
通讯作者：
Soubrane, O
中科院分区：
文献类型：
--
作者：
Fouquet, V;Alves, A;Soubrane, O
本研究的目的是回顾我们在儿童胆道闭锁（BA）原位肝移植（奥尔特）的经验，并分析生存和预后因素，以及长期结果。我们回顾了1986年至2000年间在280名儿童中进行的332例OLT。根据受者和供者的特点以及术中数据对患者和移植物存活率进行单因素和多因素分析。根据生长、免疫抑制剂治疗和肝肾功能，研究了80例奥尔特后10年生存的儿童的长期结局。最终通过肝活检记录肝移植状态。通过审查学校表现和就业情况来评估康复状况。1年、5年和10年的患者总生存率分别为85%、82%和82%，相应的移植物总生存率分别为77%、73%和71%。在多变量分析中，我们确定了4个独立的预后因素：多脾综合征（P = .03），器官共享联合网络（UNOS）状态（P = .05），供体年龄（P = .01）和围手术期手术并发症（P = .03）。移植后10年，80名儿童存活，生长速度正常。73%的长期存活者肝组织学异常，主要是由于慢性排斥反应和小叶中心纤维化。80名儿童中共有63人上了正规学校，55名儿童上了正规学校（69%）。
The aim of this study was to review our experience in orthotopic liver transplantation (OLT) for biliary atresia (BA) in children and analyze the survival and prognostic factors, and long-term outcome. We reviewed 332 OLTs performed in 280 children between the years 1986 and 2000. Univariate and multivariate analysis were performed on patient and graft survivals according to recipients' and donors' characteristics as well as intraoperative data. The long-term outcome among the 80 children living at 10 years after OLT was studied according to growth, immunosuppressive therapy, and liver and renal functions. Liver graft status was eventually documented by liver biopsy. Status of rehabilitation was assessed by reviewing school performance and employment. Overall patient survival rates at 1, 5, and 10 years were 85, 82, and 82%, respectively, and the corresponding overall graft survival rates were 77, 73, and 71%. In the multivariate analysis, we identified 4 independent prognostic factors: polysplenia syndrome (P = .03), United Network for Organ Sharing (UNOS) status (P = .05), donor's age (P = .01), and perioperative surgical complications (P = .03). At 10 years after transplant, 80 children were alive and had normal growth rates. Liver histology was abnormal in 73% of these long-term survivors, mainly due to chronic rejection and centrilobular fibrosis. A total of 63 of the 80 children attended normal school and in 55 children (69%).