儿童供肝肝移植术后早期肝动脉血栓形成对预后的影响  

Effect of hepatic artery thrombosis on the prognosis of controlled donation after circulatory death donor liver transplantation during early postoperative period in children

作　　者：张复波[1] 高伟[1] 马楠[1] 董冲[1] 孙超[1] 孟醒初[1] 张威[1] 王凯[1] 覃虹[1] 韩潮[1] 吴斌[1] 杨洋[1] 宋卓伦 郑卫萍[1] 沈中阳[1] Zhang Fubo;Gao Wei;Ma Nan;Dong Chong;Sun Chao;Meng Xingchu;Zhang Wei;Wang Kai;Qin Hong;Han Chao;Wu Bin;Yang Yang;Song Zhuolun;Zheng Weiping;Shen Zhongyang(Department of Liver Transplantation,First Central Municipal Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院移植外科,300192

出　　处：《中华器官移植杂志》2019年第11期665-668,共4页Chinese Journal of Organ Transplantation

基　　金：药物化学生物学国家重点实验室申请的开放基金研究项目(2018121)。

摘　　要：目的探讨儿童供肝肝移植术后早期肝动脉血栓形成(HAT)对于受者和移植物存活率以及胆道并发症的影响。方法回顾性分析236例儿童供肝(供体年龄<14岁)肝移植的临床资料,其中37例受者术后早期发生HAT,比较HAT组和无HAT组间术后受者和移植物的存活率,以及两组受者间术后胆道并发症的发生情况。结果236例受者术后中位随访时间为23个月,其中HAT组37例,无HAT组199例,术后中位随访时间分别为27和22个月,受者术后1年存活率分别为88.2%和93.2%,术后3年分别为88.2%和92.4%,两组间比较,差异均无统计学意义(P=0.373);术后1年移植物存活率分别为73.9%和91.8%%,术后3年分别为73.9%和90.5%,两组间比较,差异均有统计学意义(P<0.01)。两组受者术后胆漏发生率分别为13.5%和2%,胆道狭窄发生率分别为29.7%和5.5%,差异均存在统计学意义(P<0.01)。HAT组7例(18.9%)受者出现移植肝功能丧失,接受再次肝移植术。236例受者中,3例(8.1%)死亡,7例再次肝移植受者中无死亡病例。结论儿童供肝肝移植术后早期HAT可导致术后胆道并发症发生率增加,移植物丢失比例增加,对于移植物功能丧失的受者可在合适的时机行再次肝移植手术。Objective Hepatic artery thrombosis(HAT)is one of serious complications after liver transplantation.This study was intended to explore the effect of HAT on survival rate of patients/grafts and biliary complications early after liver transplantation with controlled donation after circulatory death(CDCD)donors in children.Methods The clinical data of 236 children with CDCD donor liver transplantation(donor age<14 years)were retrospectively analyzed.Among them,37 patients developed HAT early postoperatively.The survival rate of patients/grafts and the occurrence of biliary complications were compared between two groups.Results The median follow-up period was 23 months.For HAT(n=37)and non-HAT(n=199)group,the median follow-up period was 27 and 22 months respectively.The 1-year and 3-year survival rates of grafts were 88.2%,88.2%and 93.2%,92.4%respectively.And no inter-group statistical difference existed(P=0.373).The 1-year and 3-year graft survival rates were 73.9%,73.9%and 91.8%,90.5%respectively.And inter-group statistical difference existed(P<0.01).The incidence of biliary leakage and biliary stricture were 13.5%and 2%and 29.7%and 5.5%respectively.Inter-group statistical differences existed.In HAT group,there were liver failure(n=7,18.9%)and death(n=3,8.1%)after transplantation.Conclusions HAT is one of the serious complications after liver transplantation.An early onset of HAT increases the incidence of biliary complications and graft loss in children after CDCD donor liver transplantation.For patients with graft failure,liver re-transplantation may be performed at the right time.

关 键 词：儿童 供者 肝移植 肝动脉血栓形成 胆道并发症 预后 

分 类 号：R726[医药卫生—儿科]