Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg
Donor‐to‐recipient weight ratio is a risk factor for hepatic artery thrombosis after whole‐liver transplantation in children under 25 kg
复制标题
供受者体重比是25 kg以下儿童全肝移植后肝动脉血栓形成的危险因素
作者：
Stephanie S Kim;Gabriel Ramos;S. Staffa;Zahra Labib;Heung Bae Kim;K. Vakili
小儿肝移植术后肝动脉血栓形成（HAT）增加了发病率和移植物衰竭的风险。我们对2002年8月至2016年7月接受死亡供体肝移植的所有患者进行了回顾性图表审查。排除多器官移植受者。我们研究了HAT在我们机构的发生率，并试图确定相关的供体或受体风险因素。共确定了127例死亡供体肝移植患者，中位年龄为1.7岁（IQR 0.67 - 6.7）。其中，14个开发了HAT，所有重量都在25公斤以下。在100例体重低于25 kg的患者中，全肝移植受者与劈离式肝移植受者相比发生HAT的比值比为3.98（95%置信区间[CI]：1.03，15.34; P = 0.045）。在25 kg以下的全肝受体组中，11例患者发生了HAT，中位供体与受体比（DRWR）为0.9（IQR：0.7 - 1.2），而未发生HAT的患者的中位DRWR为1.4（IQR：1.1 - 1.9）。多变量分析显示，在接受全器官移植的体重低于25 kg的患者中，DRWR是HAT的独立危险因素，DRWR每降低0.5个单位，比值比为3.89（95%CI：1.43，10.54; P = .008）。我们的研究结果表明，在25 kg以下的受者中，1）劈离式肝移植可能具有较低的HAT发生率，2）选择具有较高DRWR的全器官供体可能会降低HAT的发生率。
Hepatic artery thrombosis (HAT) following pediatric liver transplantation increases morbidity and risk of graft failure. We performed a retrospective chart review of all patients who underwent deceased‐donor liver transplantation from August 2002 to July 2016. Multi‐organ transplant recipients were excluded. We examined the incidence of HAT at our institution and sought to identify associated donor or recipient risk factors. A total of 127 deceased‐donor liver transplant patients with a median age of 1.7 years (IQR 0.67‐6.7) were identified. Of those, 14 developed HAT, all weighing under 25 kg. Among 100 patients under 25 kg, whole‐liver graft recipients had an odds ratio of 3.98 (95% confidence interval [CI]: 1.03, 15.34; P = .045) for developing HAT compared with split‐liver graft recipients. Within the whole‐liver recipient group under 25 kg, 11 patients developed HAT with a median donor‐to‐recipient ratio (DRWR) of 0.9 (IQR: 0.7‐1.2) compared with a median DRWR of 1.4 (IQR: 1.1‐1.9) for those who did not develop HAT. Multivariate analysis showed DRWR to be an independent risk factor for HAT in patients weighing under 25 kg who received whole organ grafts, with an odds ratio of 3.89 (95% CI: 1.43, 10.54; P = .008) for each 0.5 unit decrease in DRWR. Our results suggest that in recipients under 25 kg 1) split‐liver grafts may have a lower rate of HAT and 2) selecting whole organ donors with a higher DRWR may decrease the incidence of HAT.