Risk factors affecting the outcomes in pediatric liver transplantation: A real-world single-center experience.
Risk factors affecting the outcomes in pediatric liver transplantation: A real-world single-center experience.
复制标题
影响小儿肝移植结果的危险因素：真实的单中心经验。
DOI：
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
K. Suh
中科院分区：
文献类型：
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作者：
S. Hong;N. Yi;K. Hong;E. Han;Jeong‐Moo Lee;Y. Choi;Kwang;K. Suh
介绍
尽管肝移植（LT）是儿科终末期肝病的标准治疗方法，但并发症往往持续存在，并可能对移植后结果产生不利影响。本研究旨在确定影响儿科LT患者结局的风险因素。
方法
回顾性分析了1988年3月至2018年12月接受初次LT的儿科患者的数据。慢性肝病定义为显示纤维化（无论级别如何）、肝硬化或任何其他可能导致进行性肝损伤（导致纤维化或肝硬化）的基础疾病的肝硬化。
结果
在研究期间，共有255例儿科患者接受了LT。其1、5和10年总生存率分别为90.5%、88.4%和87.8%。根据多因素分析，而无基础慢性肝病的肝病（p = 0.024）和儿科终末期肝病（PELD）评分≥ 30（p = 0.036）是与生存率较差相关的唯一因素，体重< 6 kg（p = 0.050）、全肝DDLT与LDLT相比（p = 0.001）、暴发性肝功能衰竭（p = 0.008）和术后肝动脉并发症（p < 0.001）与移植物存活率较差相关。无基础慢性肝病的肝病是与肝动脉并发症独立相关的唯一因素（p = 0.003）。
结论
对于无基础慢性肝病、高PELD评分或低体重的肝病儿科患者，建议更加谨慎，以提高LT后的生存率。肝动脉并发症是影响移植物生存结局的唯一手术并发症，尤其是在无基础慢性肝病的肝病患者中。
Introduction
Despite liver transplantation (LT) being the standard treatment for pediatric end-stage liver disease, complications often persist and can adversely affect the post-transplant outcomes. This study aimed to identify the risk factors affecting the outcomes in pediatric LT patients.
Methods
Data from pediatric patients who underwent primary LT from March 1988 to December 2018 were retrospectively analyzed. Chronic liver disease was defined as an explanted liver showing fibrosis regardless of grade, cirrhosis, or any other underlying disease that may cause progressive liver injury leading to fibrosis or cirrhosis.
Results
A total of 255 pediatric patients underwent LT during the study period. Their 1-, 5-, and 10-year overall survival rates were 90.5%, 88.4%, and 87.8%. According to multivariate analysis, while liver disease without underlying chronic liver disease (p = 0.024) and a pediatric end-stage liver disease (PELD) score ≥ 30 (p = 0.036) were the only factors associated with worse survival, body weight < 6 kg (p = 0.050), whole-liver DDLT compared to LDLT (p = 0.001), fulminant liver failure (p = 0.008), and postoperative hepatic artery complications (p < 0.001) were associated with worse graft survival. Liver disease without underlying chronic liver disease was the only factor independently associated with hepatic artery complications (p = 0.003).
Conclusions
Greater caution is recommended in pediatric patients with liver disease unaccompanied by underlying chronic liver disease, high PELD score, or low body weight to improve survival after LT. Hepatic artery complication was the only surgical complication affecting the graft survival outcome, especially in patients having liver disease without underlying chronic liver disease.