Pediatric living donor liver transplantation decade progress in Shanghai:Characteristics and risks factors of mortality  

作　　者：Zhi-Ying Pan Yi-Chen Fan Xiao-Qiang Wang Ling-Ke Chen Qiao-Qun Zou Tao Zhou Bi-Jun Qiu Ye-Feng Lu Cong-Huan Shen Wei-Feng Yu Yi Luo Dian-San Su 

机构地区：[1]Department of Anesthesiology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China [2]Department of Liver Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China [3]Department of Liver Transplantation,Huashan Hospital,School of Medicine,Shanghai Fudan University,Shanghai 200040,China

出　　处：《World Journal of Gastroenterology》2020年第12期1352-1364,共13页世界胃肠病学杂志（英文版）

基　　金：the National Natural Science Foundation of China,No.81571030,No.81771133 and No.81970995;Shanghai Pudong New Area Municipal Commission of Health and Family Planning Funding,No.PW2016D-4;Shanghai Jiao Tong University integration funding of Medicine and Engineering,No.YG2017MS53;Shanghai Shenkang Hospital Development Center Funding,No.SHDC12017X11.

摘　　要：BACKGROUND Pediatric living donor liver transplantation(LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, and surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare.AIM To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT.METHODS We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital.RESULTS The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%,and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period(74.47% vs 90.74%;hazard ratio: 2.92;95% confidence interval(CI): 2.16–14.14;P = 0.0004). Median duration of mechanical ventilation in the intensive care unit(ICU) was 18 h [interquartile range(IQR), 15.25–20.25], median ICU length of stay was 6 d(IQR:4.80–9.00), and median postoperative length of stay was 24 d(IQR: 18.00–34.00).Forty-seven(8.60%) of 544 patients did not receive red blood cell transfusion during the operation.CONCLUSION Pediatric end-stage liver disease score, anesthesia duration, operation duration,intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score,operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.BACKGROUND Pediatric living donor liver transplantation(LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, and surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare.AIM To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT.METHODS We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital.RESULTS The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%,and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period(74.47% vs 90.74%;hazard ratio: 2.92; 95% confidence interval(CI): 2.16–14.14; P = 0.0004). Median duration of mechanical ventilation in the intensive care unit(ICU) was 18 h [interquartile range(IQR), 15.25–20.25], median ICU length of stay was 6 d(IQR:4.80–9.00), and median postoperative length of stay was 24 d(IQR: 18.00–34.00).Forty-seven(8.60%) of 544 patients did not receive red blood cell transfusion during the operation.CONCLUSION Pediatric end-stage liver disease score, anesthesia duration, operation duration,intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score,operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.

关 键 词：Living DONOR Liver TRANSPLANTATION ANESTHESIA Survival PEDIATRIC OUTCOME 

分 类 号：R726.5[医药卫生—儿科]