小于2个月龄心脏死亡器官捐献供肝在婴幼儿肝移植中的疗效分析  

Efficacy of donation-after-cardiac-death donors aged under 2 months during infantile liver transplantation

作　　者：王兴强 陆伟[2] 刘懿禾 于立新[3] 孙雁[1] 王卫利 覃虹[3] 高伟[3] Wang Xingqiang;Lu Wei;Liu Yihe;Yu Lixin;Sun Yan;Wang Weili;Qin Hong;Gao Wei(Institute of Clinical Medicine,First Central Hospital,Tianjin Medical University,Tianjin 300192,China;Liver Cancer Center,Tianjin Medical University Cancer Institute&Hospital,Tianjin 300060,China;Department of Transplantation,First Central Municipal Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,300192 [2]天津医科大学肿瘤医院肝癌中心,300060 [3]天津市第一中心医院移植科,300192

出　　处：《中华小儿外科杂志》2020年第10期876-880,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的分析<2个月龄心脏死亡器官捐献(donation after cardiac death,DCD)供肝在婴幼儿肝移植中的临床疗效。方法回顾性分析2012年6月至2015年6月在天津市第一中心医院行肝移植的35例婴幼儿资料。其中,男21例,女14例;年龄范围为4~31个月;胆道闭锁33例,Caroli病1例,Alagille综合征1例。35例患儿的供肝由中国人体器官分配与共享系统(COTRS)分配后获得,其中男21例,女14例,年龄范围为0.5~60.0个月,体重范围为3~18 kg。根据供体年龄将患儿分为两组,其中<2个月龄组(LT组)12例,≥2个月龄组(OT组)23例。收集所有患儿的住院资料、供者资料和随访信息。比较两组患儿术后并发症发生率,Kaplan-meier法分析两组患儿的生存情况。结果比较两组患儿和供者的资料,发现患儿的身高、体重,术后即刻血清丙氨酸转氨酶(ALT)、总胆红素(TBIL);供者的身高、体重及供肝质量、移植物受体体重比(graft to recipient weight ratio,GRWR)在两组间的差异具有统计学意义(P<0.05)。LT组中,肝动脉栓塞3例,门静脉狭窄1例,胆道并发症1例,术后肺感染3例,无急性排斥反应和EB病毒(Epstein-Barr virus,EBV)感染,巨细胞病毒(cytomegalovirus,CMV)感染1例。OT组中,肝动脉栓塞21.7%(5/23),门静脉狭窄26.1%(6/23),胆道并发症13.0%(3/23),术后肺感染34.8%(8/23),急性排斥反应17.4%(4/23),EBV感染34.8%(8/23),CMV感染39.1%(9/23)。两组患儿术后并发症发生率的差异无统计学意义(P>0.05);Kaplan-meier生存分析显示,LT组患儿1、3、5年累积生存率均为91.7%,OT组患儿1、3、5年累积生存率均为91.3%;两组间差异无统计学意义(χ2=0,P>0.05)。结论<2个月龄DCD供肝可用于婴幼儿肝移植,不增加术后并发症发生率,受者可获得满意远期生存。Objective To explore the clinical effect of donation-after-cardiac-death (DCD)donors aged under 2 months during infantile liver transplantation (LT).Methods A total of 35 infants undergoing LT at First Central Hospital from June 2012 to June 2015 were retrospectively analyzed. Among them, there were 21 males and 14 females, aged from 4 to 31 months, 33 with biliary atresia, 1 with Caroli's disease and 1 with Alagille syndrome. Thirty five patients were assigned by the Chinese organ allocation and sharing system (COTRS). There were 21 males and 14 females, aged 0.5-60 months and weighing 3-18 kg. Based upon donor age, they were divided into two groups of <2 months (LT, n=12) and ≥2 months (OT, n=23). Hospitalization records, donor data and follow-up profiles were collected. The incidence of postoperative complications was compared between two groups. And Kaplan-Meier method was employed for analyzing the survival of two groups.Results Height, weight, serum alanine aminotransferase (ALT), total bilirubin (TBIL), height, weight, liver weight and graft to recipient weight ratio (GRWR) were significantly different between two groups (P<0.05). In LT group, there were hepatic artery embolism (n=3), portal vein stenosis (n=1), biliary complications (n=1), postoperative pulmonary infection (n=3), acute rejection or EBV infection (n=0) and CMV infection (n=1);In OT group, hepatic artery embolism (21.7%, 5/23), portal vein stenosis (26.1%, 6/23), biliary complications (13.0%, 3/23), postoperative pulmonary infection (34.8%, 8/23), acute rejection (17.4%, 4/23), EBV infection (34.8%, 8/23) and CMV infection (39.1%, 9/23). No significant inter-group difference existed in the incidence of postoperative complications (P>0.05). Kaplan-Meier survival analysis showed that the 1/3/5-year cumulative survival rates were 91.7% in group A and 91.3% in group OT. There was no significant inter-group difference (χ2=0, P>0.05).Conclusions DCD donors aged <2 months may be utilized for infantile LT without an elevated incidence of complic

关 键 词：肝移植 心脏死亡器官捐献 供肝 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]