儿童再次肝移植病因及预后分析  

Clinical study of causes and outcomes in pediatric liver retransplantation

作　　者：孙超[1] 董冲[1] 孟醒初[1] 王凯[1] 覃虹[1] 韩潮[1] 杨洋[1] 张复波[1] 郑卫萍[1] 宋卓伦 李豪豪 高伟[1] 沈中阳[1] Sun Chao;Dong Chong;Meng Xingchu;Wang Kai;Qin Hong;Han Chao;Yang Yang;Zhang Fubo;Zheng Weiping;Song Zhuolun;Li Haohao;Gao Wei;Shen Zhongyang(Organ Transplant Center,Tianjin First Central Hospital,Tianjin Key Laboratory for Organ Transplantation,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院器官移植中心天津市器官移植重点实验室,300192

出　　处：《中华外科杂志》2021年第5期353-358,共6页Chinese Journal of Surgery

基　　金：天津市卫生行业重点攻关项目(16KG107)。

摘　　要：目的探讨儿童再次肝移植的病因、临床特征及预后。方法回顾性收集2014年1月至2019年12月于天津市第一中心医院儿童器官移植科接受肝移植治疗的1024例患儿(<18岁)的临床资料,其中再次肝移植25例(26例次)。二次肝移植24例,三次肝移植1例。25例患儿中,男13例,女12例。再次移植手术时中位年龄[M(Q_(R))]为12.9(20.5)个月(范围:5.8~134.8个月),体重为8.0(5.6)kg(范围:5.0~30.0 kg),儿童终末期肝病(PELD)评分为17.0(21.3)分(范围:0~45分)。再次肝移植的病因:胆道并发症(7例次)、移植肝原发无功能(5例次)、抗体介导排斥(4例次)、肝动脉血栓形成(3例次)、门静脉血栓形成(3例次)、肝动脉血栓形成合并门静脉血栓形成(2例次)、下腔静脉闭塞(1例次)、窦状隙梗阻综合征(1例次)。按两次移植间隔时间30 d为界线,早期(≤30 d)再移植8例次,晚期(>30 d)再移植18例次。比较两组患者再次肝移植的病因、术前PELD评分、与前次肝移植间隔时间、手术情况、主要并发症及生存情况。符合正态分布的计量资料采用t检验进行比较分析;非正态分布的计量资料采用Mann-WhitneyU检验进行比较分析。计数资料采用χ^(2)检验进行比较分析。采用Kaplan-Meier法进行生存分析,并进行Log-rank检验。结果本组病例的中位随访时间为26.8(30.2)个月(范围:1 d至85.7个月),再次肝移植的发生率为1.9%(19/998)。早期再移植组手术时间为(439.8±151.0)min,供肝重量与受者体重比为5.0(1.8)%(范围:3.6%~6.1%),再移植病因主要为移植肝原发无功能及血管并发症;晚期再移植组手术时间为(604.4±158.0)min,供肝重量与受者体重比为3.4(2.1)%(范围:1.4%~5.3%),再移植病因主要为胆道并发症、抗体介导的排斥反应及血管并发症。早期再移植受者术后3个月、1年、2年累积总体生存率均为62.5%;晚期再移植受者术后3个月、1年、2年累积总体生存率分别为100%、93.8%、93.8%Objective To investigate the etiology,clinical features and prognosis of pediatric liver retransplantation.Methods The data of 1024 cases of pediatric liver transplantation(<18 years old)from January 2014 to December 2019 operated at Tianjin First Central Hospital were collected,retrospectively.Retransplantation was performed in 26 cases,among which 25 cases received secondary liver transplantation and 1 case received a third liver transplantation.There were 13 male and 12 female patients among the 25 patients.The median age was 12.9(20.5)months(range:5.8 to 134.8 months),the body weight was 8.0(5.6)kg(range:5.0 to 30.0 kg)at the time of retransplantation.The pediatric end-stage liver disease(PELD)score was 17.0(21.3)(range:0 to 45)before retransplantation.The etiology of retransplantation was biliary complications in 7 cases,primary nonfunction of liver graft in 5 cases,antibody-mediated rejection in 4 cases,hepatic artery thrombosis in 3 cases,portal vein thrombosis in 3 cases,concomitant hepatic artery and portal vein thrombosis in 2 cases,thrombogenesis of inferior Vena Cava in 1 case and sinusoidal obstruction syndrome in 1 case.The patients were divided into two groups according to the time interval(30 days)between two liver transplantations,8 patients were classified into early-retransplantation(≤30 days)group and 18 patients were classified into late-retransplantation(>30 days)group.The etiology of liver retransplantation,pre-transplant score,time interval between two transplantations,surgical aspects,major complications and survival rates were compared between the two groups.Continuous variables with normal distribution were compared with t test,while Mann-Whitney U test was applied to compare variables without normal distribution.Categorical variables were compared with chi-square test.The survival curves were created by Kaplan-Meier method and compared by Log Rank test.Results The median follow-up time was 26.8(30.2)months(range:1 day to 85.7 months),and the incidence of retransplantation was 1.9%.In

关 键 词：肝移植 儿童 再移植 生存率 

分 类 号：R726.5[医药卫生—儿科]