Deceased donor liver transplantation in infants and small children: are partial grafts riskier than whole organs?
Deceased donor liver transplantation in infants and small children: are partial grafts riskier than whole organs?
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DOI：
10.1002/lt.23667
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发表时间：
2013-07
影响因子：
4.6
通讯作者：
Kim, Heung Bae
中科院分区：
文献类型：
--
作者：
Cauley, Ryan P.;Vakili, Khashayar;Potanos, Kristina;Fullington, Nora;Graham, Dionne A.;Finkelstein, Jonathan A.;Kim, Heung Bae
在所有肝移植候选者中，婴儿的候补死亡率最高。虽然之前的研究表明，幼儿在接受成人和青少年已故捐赠者 (DD) 的部分移植物时可能面临更大的风险，而可用的大小匹配的器官很少，但这些移植物已越来越多地用于扩大儿科捐赠者库。我们的目的是确定 DD 部分肝年轻儿科接受者当前调整后的移植失败和死亡风险，并确定这些风险是否随时间变化。我们分析了 UNOS 数据库（1995-2010 年）中 2,683 名 2 岁以下首次 DD 肝脏接受者，其中包括 1,118 名 DD 部分肝脏和 1,565 名 DD 整个器官。双变量分析中与移植物丢失相关的移植因素（p<0.1）被纳入移植物和患者生存的多变量比例风险模型中。交互分析用于检查随时间变化的风险（时间段：1995-2000、2001-2005、2006-2010）。虽然 1995-2000 年不同移植物类型的粗移植物存活率存在显着差异 (p<.001)，但 2001-2005 年 (p=.43) 和 2006-2010 年 (p=.36) 部分移植物和整个移植物之间的移植物存活率相当。此外，虽然 1995-2000 年部分移植失败和死亡的调整后风险分别为 1.40 (1.05-1.89) 和 1.41 (0.95-2.09)，但 2006-2010 年部分和整个器官移植失败和死亡的调整风险具有可比性（移植失败 HR .81 95%CI .56-1.18；死亡率 HR 1.02 95%CI .66-1.71）。随着时间的推移，死者供体部分肝移植的风险已降低，现在与婴儿和幼儿的全肝移植具有可比的结果。
Infants have the highest waitlist mortality of all liver transplant candidates. While previous studies have demonstrated that young children may be at increased risk when receiving partial grafts from adult and adolescent deceased donors (DD), with few size-matched organs available, these grafts have increasingly been used to expand the pediatric donor pool. We aimed to determine the current adjusted risk of graft failure and mortality in young pediatric recipients of DD partial livers, and to determine if these risks have changed over time. We analyzed 2,683 first-time DD liver-alone recipients under the age of 2 years in the UNOS database (1995-2010), including 1,118 DD partial livers and 1,565 DD whole organs. Transplant factors associated with graft loss on bivariate analyses (p<0.1) were included in multivariable proportional hazards models of graft and patient survival. Interaction analysis was used to examine risks over time (time-periods:1995-2000, 2001-2005, 2006-2010). While there were significant differences in crude graft survival by graft type in 1995-2000 (p<.001), graft survival between partial and whole grafts was comparable in 2001-2005 (p=.43) and 2006-2010 (p=.36). Furthermore, while the adjusted hazards of partial graft failure and mortality were 1.40 (1.05-1.89) and 1.41 (.95-2.09) respectively in 1995-2000, the adjusted risk of graft failure and mortality was comparable between partial and whole organs in 2006-2010 (Graft failure HR .81 95%CI .56-1.18; Mortality HR 1.02 95%CI .66-1.71). Deceased-donor partial liver transplantation has become less risky over time, and now has comparable outcomes to whole liver transplantation in infants and young children.
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DOI：
10.1111/j.1600-6143.2011.03972.x
发表时间：
2012-05
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
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作者：
Abecassis MM;Fisher RA;Olthoff KM;Freise CE;Rodrigo DR;Samstein B;Kam I;Merion RM;A2ALL Study Group
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影响因子：
8.8
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Berg, C. L.;Steffick, D. E.;Mazariegos, G. V.
通讯作者：
Mazariegos, G. V.
影响因子：
8.8
作者：
Roberts, JP;Hulbert-Shearon, TE;Port, FK
通讯作者：
Port, FK
影响因子：
1.3
作者：
Arnon, Ronen;Annunziato, Rachel;Kerkar, Nanda
通讯作者：
Kerkar, Nanda