Long-term outcomes of 600 living donor liver transplants for pediatric patients at a single center
Long-term outcomes of 600 living donor liver transplants for pediatric patients at a single center
复制标题
DOI：
10.1002/lt.20826
复制
发表时间：
2006-09-01
影响因子：
4.6
通讯作者：
Tanaka, Koichi
中科院分区：
文献类型：
--
作者：
Ueda, Mikiko;Oike, Fumitaka;Tanaka, Koichi
本报告关注在单一中心的儿科患者活体供肝移植（LDLT）的长期结果。在1990年6月至2003年12月期间，共有600例ldlt患者接受了FK506和低剂量皮质类固醇的免疫抑制治疗，其中包括568例原发性移植和32例再移植。患者1年、5年和10年生存率分别为84.6%、82.4%和77.2%，相应的移植物存活率分别为84.1%、80.9%和74.5%。多因素分析表明，暴发性肝衰竭（FHF）、移植物与体重（GBWR）之比< 0.8和abo血型不相容的移植与患者和移植物的生存均独立相关。再移植率为6%，55例（9.7%）患者已完全停用免疫抑制剂。我们发现，在我院的一大批儿童中，儿童LDLT术后患者和移植物的长期生存率与尸体肝移植的长期生存率一样好，尽管该系列包括13%的abo血型不相容供体的肝移植，其患者和移植物存活率明显低于尸体肝移植。为了使FHF患者和abo血型不相容移植患者获得更好的结果，需要改进免疫抑制治疗。
This report concerns the long-term outcome of living donor liver transplantation (LDLT) for pediatric patients at a single center. Between June 1990 and December 2003, a total of 600 LDLTs, including 568 primary transplantations and 32 retransplantations, were performed for pediatric patients, who were immunosuppressed with FK506 and low-dose corticosteroids. Patient survival at 1, 5, and 10 years were 84.6%, 82.4%, and 77.2%, respectively, and the corresponding findings for graft survivals were 84.1%, 80.9%, and 74.5%. Multivariate analysis demonstrated that fulminant hepatic failure (FHF), a graft vs. body weight (GBWR) ratio of < 0.8, and ABO-incompatible transplants were independently associated with both patient and graft survival. The retransplantation rate was 6%, and 55 patients (9.7%) have been completely weaned off immunosuppressants. Long-term patient and graft survival after pediatric LDLT for a large cohort of children at our hospital were found to be as good as those for cadaveric liver transplantation, although this series includes 13% liver transplantations with ABO-incompatible donors, which are obviously inferior in patient and graft survival. To obtain better outcomes for patients with FHF and for patients with ABO-incompatible transplants, immunosuppressive therapy needs to be improved.