脂肪变性供肝对儿童活体肝移植供受者预后的影响  

The effect of steatotic donor livers on the prognosis of donors and recipients after pediatric living donor liver transplantation

作　　者：杨洋[1] 董冲[1] 孙超[1] 王凯[1] 张威[1] 郑卫萍[1] 张复波[1] 覃虹[1] 韩潮[1] 王振[1] 徐敏 高伟[1] Yang Yang;Dong Chong;Sun Chao;Wang Kai;Zhang Wei;Zheng Weiping;Zhang Fubo;Qin Hong;Han Chao;Wang Zhen;Xu Min;Gao Wei(Department of Pediatric Organ Transplantation,Organ Transplantation Center,Tianjin First Central Hospital,Key Laboratory of Transplantation,Chinese Academy of Medical Sciences,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院器官移植中心儿童器官移植科,中国医学科学院移植医学重点实验室,天津300192

出　　处：《中华外科杂志》2022年第10期922-929,共8页Chinese Journal of Surgery

基　　金：国家自然科学基金(82170672);天津市医学重点学科(专科)建设项目。

摘　　要：目的探讨脂肪变性供肝对儿童活体肝移植供者的安全性及供受者预后的影响。方法回顾性分析2013年1月至2020年12月天津市第一中心医院器官移植中心儿童器官移植科完成的814例儿童活体肝移植中供者和受者的临床资料。根据供肝是否存在脂肪变性将供者和受者分为非脂肪变性供肝组(n=733)和脂肪变性供肝组(n=81),根据脂肪变性程度将脂肪变性供肝组再分为轻度及中度脂肪变性两个亚组。非脂肪变性供肝组供者中,男性307例,女性426例,中位年龄30岁(范围:18~57岁);受者中男性351例,女性382例,中位年龄7个月(范围:4个月至14岁)。脂肪变性供肝组供者中,男性41例,女性40例,中位年龄31岁(范围:22~51岁);受者中男性34例,女性47例,中位年龄8个月(范围:5个月至11岁)。术后通过门诊复查、问卷调查等方法对供受者进行定期随访。分别使用t检验、Wilcoxon秩和检验、重复测量方差分析、χ^(2)检验或Fisher确切概率法对各组数据进行统计学分析。采用Kaplan-Meier法绘制各组中受者和移植物生存曲线,并应用Log-rank检验比较脂肪变性供肝组和非脂肪变性供肝组受者生存率和移植物存活率。结果两组供者性别分布的差异无统计学意义(P=0.132),年龄、血型分布、体重、体重指数的差异均有统计学意义(P值均<0.05)。脂肪变性供肝组与非脂肪变性供肝组比较,供者术后1、2、5 d及1个月时肝功能指标ALT、AST的恢复无明显差异(P值均>0.05),但手术时间更长[(294±75)min比(264±81)min,t=3.149,P=0.002],术后胆瘘[3.7%(3/81)比0.5%(4/733),P=0.025]和切口延期愈合[7.4%(6/81)比2.0%(15/733),P=0.013]比例增加。两组受者性别分布、年龄、血型分布、身高、体重及儿童终末期肝病模型评分的差异均无统计学意义(P值均>0.05)。脂肪变性供肝组与非脂肪变性供肝组相比,受者术后2周内肝功能指标ALT、AST及总胆红素的变化无差异(P值�Objectives To evaluate the effects of steatotic donor livers on the safety of donors and the prognosis of donors and recipients in pediatric living donor liver transplantation.Methods A total of 814 pediatric living donor liver transplantations were performed between January 2013 and December 2020 at Department of Pediatric Organ Transplantation,Tianjin First Central Hospital.The clinical data were collected and a retrospective study was conducted.The recipients and the donors were divided into non-steatotic donor liver group(n=733)and steatotic donor liver group(n=81)according to whether the donor graft had steatosis.The recipients and the donors in the steatotic donor liver group were further divided into mild and moderate steatosis groups based on the degree of liver steatosis.Among the donors of non-steatosis donor group,there were 307 males and 426 females,with a median age of 30 years(range:18 to 57 years);the recipients included 351 males and 382 females,with a median age of 7 months(range:4 month to 14 years).Among the donors of steatosis donor group,there were 41 males and 40 females,with a median age of 31 years(range:22 to 51 years);the recipients included 34 males and 47 females,with a median age of 8 months(range:5 months to 11 years).The donors and the recipients were followed up regularly by means of outpatient reexamination and questionnaire survey after operation.Statistical analysis of data between groups was performed using t-test,Wilcoxon rank-sum test,repeated measures ANOVA,χ^(2) test,or Fisher′s exact test,respectively.The survival curves of recipients and grafts in different groups were created by Kaplan-Meier method,and the survival rates of the steatotic donor liver group and the non-steatotic donor liver group were compared by Log-rank method.Results There was no significant difference in the gender of donors in both groups(P=0.132).There were significant differences in the age and blood type distribution as well as body weight and body mass index(all P<0.05)between the two groups.No

关 键 词：肝移植 儿童 脂肪变性供肝 活体供者 

分 类 号：R726.5[医药卫生—儿科]