Impact of surgical and immunological parameters in pediatric liver transplantation - A multivariate analysis in 500 consecutive recipients of primary grafts
Impact of surgical and immunological parameters in pediatric liver transplantation - A multivariate analysis in 500 consecutive recipients of primary grafts
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DOI：
10.1097/01.sla.0000108681.24374.02
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发表时间：
2004-02-01
影响因子：
9
通讯作者：
Reding, R
中科院分区：
文献类型：
--
作者：
Evrard, V;Otte, JB;Reding, R
目的：评价外科和免疫学因素对儿童肝移植后患者/移植物结局和排斥反应的影响。摘要背景资料：原位肝移植是治疗儿童急性肝功能衰竭和终末期肝病的有效方法。在文献中，只有少数关于影响儿童原位肝移植结果的因素的大型研究。关于排斥反应对移植物预后影响的研究在成人原位肝移植中很少，甚至在儿科受者中也是如此。方法：回顾1984年3月至2000年7月间500例接受初级原位肝移植的儿科受者的资料。主要指征为胆道闭锁(n=328)。自1993年7月以来，82例(16%)患儿采用亲属活体供肾移植，计算存活率并进行多因素分析。结果：1、5、10年存活率分别为85%、81%、79%，移植物分别为76%、71%、70%。在多变量分析中，只有3个因素被发现与较好的患者生存独立相关：移植年份(P=0.001)、移植前诊断(P<；0.001，肝脏肿瘤最差结果)和ABO配型(P<；0.001，ABO血型不合最差结果)。同样，有3个因素与较好的无排斥移植物存活率独立相关：作为主要免疫抑制剂的他克莫司(P<；0.001)，阴性T细胞交叉匹配(P=0.016)，以及供者的年轻(P<；0.001)。结论：儿童原位肝移植是一项复杂的任务，对结果有多因素影响：(1)强烈的学习曲线效应影响总体结果；(2)儿童肝肿瘤仍然是一个具有挑战性的适应症；(3)初级免疫预防联合他克莫司可提供较低的排斥发生率；(4)供者年龄的年轻化效应值得进一步研究。
Objective: To assess the respective impact of surgical and immunologic factors on patient/graft outcome and rejection after pediatric liver transplantation.Summary Background Data: Orthotopic liver transplantation (OLT) constitutes a validated therapeutic modality for acute liver failure and end-stage liver disease in children. Only a few large studies of factors influencing outcome of pediatric OLT are available in the literature. Studies considering the impact of rejection on graft outcome are scarce in adult OLT and are not even available for pediatric recipients.Methods: Five hundred consecutive pediatric recipients ( < 15 years) of a primary OLT performed between March 1984 and July 2000 were retrospectively reviewed. The main indication was biliary atresia (n = 328). A living related donor graft was used from July 1993 onwards in 82 children (16%), Survival was calculated and multivariate analysis was performed.Results: Actuarial survival rates at 1, 5, and 10 years were 85%, 81%, and 79% for patients, and 76%, 71%, and 70% for grafts, respectively. At the multivariate analysis, only 3 factors were found to be independently correlated with better patient survival: year of transplantation (P = 0.001), pretransplant diagnosis (P < 0.001, worst results for liver tumors), and ABO matching (P < 0.001, worst results for ABO incompatibility). Similarly, 3 factors were independently correlated with better rejection-free graft survival: tacrolimus as primary immunosuppressant (P < 0.001), a negative T-cell crossmatch (P = 0.016), and younger age of the donor (P < 0.001).Conclusions: Pediatric OLT constitutes a complex undertaking with multifactorial impact on results: (1) a strong learning curve effect was shown to impact on overall results; (2) pediatric liver tumors still represent a challenging indication for OLT; (3) primary immunoprophylaxis with tacrolimus provided a lower rejection incidence; (4) the younger donor age effect deserves further immunologic investigations.