儿童肝移植受者术后的长期存活及其影响因素分析  

Risk factors associated with long-term outcomes after pediatric liver transplantation

作　　者：刘源[1] 王炳然 封明轩[1] 周韬[1] 罗毅[1] 夏强[1] Liu Yuan;Wang Bingran;Feng Mingxuan;Zhou Tao;Luo Yi;Xia Qiang(Department of Liver Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院肝脏外科,上海200127

出　　处：《中华器官移植杂志》2024年第5期308-314,共7页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(82000586,82241221);上海市2021年度"科技创新行动计划"一带一路"国际合作项目(21410750400);上海市高水平地方高校创新团队项目(SHSMU-ZLCX20211600)。

摘　　要：目的探究儿童肝移植受者的长期存活情况及其影响因素。方法回顾性分析2006年10月至2022年12月在上海交通大学医学院附属仁济医院接受肝移植手术治疗的3004例(其中二次移植40例)终末期肝病患儿的临床背景、手术信息、围手术期管理和长期随访资料,通过Kaplan-Meier法分析肝移植术后受者和移植物的存活率;分别比较接受活体肝移植和遗体捐献肝移植、移植时体重≤5 kg和>5 kg、年龄≤5个月和>5个月、移植物受者体重比率(graft recipient weight ratio,GRWR)≤5%和>5%、供受者血型相容和不相容受者的存活率及2006年至2011年、2012年至2017年和2018年至2022年的受者存活率。分析并发症的发生情况。采用Cox回归分析法分析受者长期存活的影响因素,并将P<0.05者纳入LASSO回归分析模型,分析受者长期存活的独立危险因素。结果截至2022年12月,上海交通大学医学院附属仁济医院儿童肝移植受者的1、5、10年总存活率分别为95.1%(2819/2964)、93.1%(2759/2964)、91.8%(2721/2964),移植物的1、5、10年存活率分别为94.5%(2839/3004)、92.0%(2764/3004)、86.2%(2589/3004)。受者5年存活率:2006年至2011年为71.6%(63/88),2012年至2017年为91.6%(1009/1101),2018年至2022年的95.5%(1695/1775)。体重≤5 kg和GRWR>5%受者存活率分别为83.7%(41/49)和90.0%(378/420),较体重>5 kg和GRWR≤5%的94.4%(2746/2915)和94.6%(2406/2544)低,差异均有统计学意义(P=0.007和0.001)。受者手术年龄和供受体血型相容性与移植术后存活率差异均无统计学意义(P=0.26和0.40)。感染[35.3%(70/198)]和外科并发症[24.2%(48/198)]是移植术后受者的主要死亡原因,感染[35.7%(25/70)]、门静脉并发症[18.6%(13/70)]和肺部损伤[15.7%(11/70)]是移植术后1个月内受者的主要死亡原因。术后感染和急性排斥反应的发生率分别从2006年至2011年的86.5%(76/88)和38.2%(34/88)下降到2018年至2022年的75.5%(1340/1775)和22.2%(394/1775)。移植Objective To explore the overall efficacy of pediatric liver transplantation(LT)and the risk factors affecting the long-term outcomes.Methods From October 2006 to December 2022,clinical profiles,intraoperative findings,perioperative managements and long-term follow-ups were retrospectively reviewed for 3004 cases(including 40 cases of retransplantation)of children with end-stage liver disease undergoing LT.Overall patient and graft survival rates after transplantation were explored by Kaplan-Meier survival curve.The survival rates of recipients receiving living donor liver transplantation and deceased donor liver transplantation,recipients with body weight≤5 kg and>5 kg at the time of transplantation,recipients with age≤5 months and>5 months,graft recipient weight ratio(GRWR)≤5%and>5%,and recipients with compatible and incompatible blood types were compared,as well as the survival rates of recipients from 2006 to 2011,2012 to 2017,and 2018 to 2022.The occurrence of complications was analyzed.Cox regression was used to analyze the risk factors of long-term mortality,and those with<0.05 were included in the LASSO regression model to identify the independent risk factors.Results As of December 2022,overall survivals at 1/5/10-year were 95.1%(2819/2964),93.1%(2759/2964)and 91.8%(2721/2964)and 1/5/10-year graft survival rate 94.5%(2839/3004),92.0%(2764/3004)and 86.2%(2589/3004).The 5-year survival rate improved:Five-year survival rate at pediatric LT centers were 71.6%(63/88,from 2006 to 2011),91.6%(1009/1101,from 2012 to 2017)and 95.5%(1695/1775,from 2018 to 2022).Survival rates were lower in recipients with body weight≤5 kg[83.7%(41/49)vs 94.4%(2746/2915),P=0.001)]and GRWR>5%[90.0%(378/420)vs 94.6%(2046/2544),P=0.007]compared to those>5 kg and≤5%.Difference in surgical age and blood type compatibility were not statistically(P=0.26 and 0.4).Infection[35.3%(70/198)]and surgical complications[24.2%(48/198)]were the main causes of mortality after transplantation.While infection[35.7%(25/70)],portal vein compli

关 键 词：肝移植 儿童 儿童肝移植 长期存活 危险因素 感染 

分 类 号：R726.5[医药卫生—儿科]