儿童供肝在成人肝移植中应用的单中心研究  

Outcome of pediatric-to-adult liver transplantation:a single-center study in China

作　　者：俞浩[1] 厉智威[2] 王融溶[3] 张微[2] 白雪莉[1] 梁廷波[1] Yu Hao;Li Zhiwei;Wang Rongrong;Zhang Wei;Bai Xueli;Liang Tingbo(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Liver Transplant Center,the First Affiliated Hospital,Zhejing University School of Medicine,Hangzhou 310003,China;Department of Clinical Pharmacy,the First Affiliated Hosppital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,杭州310003 [2]浙江大学医学院附属第一医院肝移植中心,杭州310003 [3]浙江大学医学院附属第一医院临床药学部,杭州310003

出　　处：《中华外科杂志》2022年第10期915-921,共7页Chinese Journal of Surgery

摘　　要：目的探讨儿童供肝成人肝移植的治疗效果及影响移植物存活的相关因素。方法回顾性收集2015年1月至2021年8月浙江大学医学院附属第一医院完成的55例儿童供肝成人肝移植的临床资料。供者中男性34例,女性21例,年龄(11.8±4.7)岁(范围:1~17岁)。17例(30.9%)为脑死亡器官捐献(DBD)供肝,32例(58.2%)为心脏死亡器官捐献供肝,6例(10.9%)为脑-心双死亡器官捐献供肝。受者中男性32例,女性23例,年龄(51.6±10.1)岁(范围:27~70岁),其中10例患者为血型不合肝移植(18.2%)。通过Student t检验、Mann-Whitney U检验或χ^(2)检验分析移植物早期存活(术后90 d)的相关因素,通过Kaplan-Meier法绘制移植物存活曲线,采用Logistic多因素分析术后早期移植物失活的独立相关因素。结果随访截至2021年10月31日,中位随访时间[M(IQR)]为36.0(43.1)个月(范围:5.9~81.7个月),移植物失活13例(其中2例因急性肝功能衰竭行再次肝移植)。单因素分析结果显示,冷缺血时间、供受者血型是否相合是早期移植物存活的相关因素(P值均<0.05);多因素分析结果显示,冷缺血时间及受者消化道出血史是其独立相关因素(P值均<0.05)。55例受者中,术后发生肝动脉血栓3例(5.5%),门静脉血栓4例(7.3%),门静脉狭窄2例(3.6%),胆道系统并发症7例(12.7%),小肝综合征8例(14.5%)。结论儿童供肝成人肝移植是治疗终末期肝病的有效方法,冷缺血时间及受者是否有消化道出血病史是影响早期移植物存活的独立相关因素。Objective To explore the outcome of the pediatric-to-adult liver transplantation,including postoperative complications and relevant factors which affecting graft survival.Methods Data of 55 patients undergoing pediatric-to-adult liver transplantation at the First Affiliated Hospital of Zhejiang University between January 2015 and August 2021 were retrospectively analyzed.The donors consisted of 34 males and 21 females,and the age was(11.8±4.7)years(range:1 to 17 years).Among the cases,17 cases(30.9%)were donation of brain death,32 cases(58.2%)were donation of cardiac death,and 6 cases(10.9%)were donation after brain death plus cardiac death.The recipients consisted of 32 males and 23 females,and the age was(51.6±10.1)years(range:27 to 70 years).Among the recipients,10 cases(18.2%)were ABO-incompatible liver transplantation.The influencing factors of early graft survival were analyzed by Student t test,Mann-Whitney U test orχ^(2) test,respectively.Survival curve was drawn by Kaplan-Meier method.Logistic multivariate analysis was used to analyze the independent relevant factors of early postoperative graft loss.Results Up to October 31,2021,the follow-up time(M(IQR))was 36.0(43.1)months(range:5.9 to 81.7 months).There were 13 cases with graft loss(two of them underwent re-transplantation due to acute liver failure).The monofactor analysis indicated that cold ischemia time and donor-recipient blood group matching were the relevant factors affecting the early graft survival rate(both P<0.05).Logistic multivariate analysis showed that cold ischemia time and history of recipient gastrointestinal bleeding were independent relevant factors(both P<0.05).Postoperative hepatic artery thrombosis occurred in 3 cases(5.5%),portal vein thrombosis diagnosed in 4 cases(7.3%),portal vein stenosis occurred in 2 cases(3.6%),biliary complications diagnosed in 7 cases(12.7%),and small liver syndrome was found in 8 cases(14.5%).Conclusions Adult liver transplantation with pediatric donor liver is an effective method to treat end-sta

关 键 词：肝移植 术后并发症 儿童供肝 早期移植物存活率 相关因素 

分 类 号：R726.5[医药卫生—儿科]