Pediatric Liver Transplant Recipients Who Undergo Transfer to the Adult Healthcare Service Have Good Long-Term Outcomes
Pediatric Liver Transplant Recipients Who Undergo Transfer to the Adult Healthcare Service Have Good Long-Term Outcomes
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DOI：
10.1111/ajt.13184
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发表时间：
2015-07-01
影响因子：
8.8
通讯作者：
Ferguson, J. W.
中科院分区：
文献类型：
--
作者：
Sagar, N.;Leithead, J. A.;Ferguson, J. W.
肝移植改变了患有肝病的儿童的生存状况，需要将越来越多的患者转移到成人保健服务机构。转移对结果的影响尚不清楚。这项针对137名连续接受肝移植的儿童的单中心研究的目的是检查肝移植对患者和移植物存活的影响。从移植到移植的中位时间为10.4年，移植时患者的中位年龄为18.6岁。移植后，14例患者中有5例再次移植，12例死亡。移植后10年患者和移植物存活率分别为89.9%和86.2%。总体而言，4例患者表现出慢性排斥反应导致移植物丧失。移植物损失与首次移植时年龄较大相关（p=0.008）。与在成人中心移植的年轻成人患者相比，移植患者从移植点开始的移植物存活率并不低（HR 0.28; 95% CI 0.10-0.77, p=0.014）。这表明移植物对移植物寿命没有显著影响。总之，儿童肝移植受者接受转移到成人服务有良好的长期预后。
Liver transplantation has transformed survival for children with liver disease necessitating the transfer of a growing number of patients to the adult healthcare service. The impact of transfer on outcomes remains unclear. The aim of this single-center study of 137 consecutive pediatric liver transplant recipients was to examine the effect of transfer on patient and graft survival. The median time from transplant to transfer was 10.4 years and the median age of the patients at transfer was 18.6 years. After transfer, there were 5 re-transplants and 12 deaths in 14 patients. The estimated posttransfer 10-year patient and graft survival was 89.9% and 86.2%, respectively. Overall, 4 patients demonstrated graft loss as a consequence of chronic rejection. Graft loss was associated with older age at first transplant (p=0.008). When compared to young adult patients transplanted in the adult center, the transferred patients did not have inferior graft survival from the point of transfer (HR 0.28; 95% CI 0.10-0.77, p=0.014). This suggests that transfer did not impact significantly on graft longevity. In conclusion, pediatric liver transplant recipients who undergo transfer to the adult service have good long-term outcomes.