移植物受者体重比率对劈离式肝移植儿童受者早期预后的影响  

Effects of graft recipient weight ratio on early prognosis of split liver transplantation in children

作　　者：李林潇 董冲[2] 孙超[2] 王凯[2] 杨洋[2] 王振[2] 魏新哲 崔甘霖 李维涵 高伟[2] Li Linxiao;Dong Chong;Sun Chao;Wang Kai;Yang Yang;Wang Zhen;Wei Xinzhe;Cui Ganlin;Li Weihan;Gao Wei(Central College I of Clinical Medicine,Tianjin Medical University,Tianjin 300192,China;Department of Pediatric Liver Transplantation,Organ Transplantation Center,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,天津300192 [2]天津市第一中心医院器官移植中心儿童器官移植科,天津300192

出　　处：《中华器官移植杂志》2024年第5期315-322,共8页Chinese Journal of Organ Transplantation

摘　　要：目的探讨移植物受者体重比率(graft recipient weight ratio,GRWR)对不同年龄儿童劈离式肝移植受者术后早期(术后1年内)预后的影响。方法回顾性分析2015年4月至2022年12月在天津市第一中心医院儿童器官移植科行首次劈离式肝移植术的年龄在12岁以内188例儿童受者的临床资料。根据手术时年龄将所有受者分为L组(年龄≤18个月,123例)和H组(18个月<年龄≤12岁,65例)。绘制GRWR预测H组和L组受者存活率的受试者工作特征曲线,确定GRWR的截断值并根据该值大小进行分组。所有受者随访至术后12个月、死亡或再移植。比较受者的一般情况、术中情况、术后情况及主要并发症。采用Kaplan-Meier法分析比较术后早期受者和移植物存活率,采用χ^(2)检验或Fisher确切概率法比较术后主要并发症发生率。结果根据确定的GRWR值(3.1%)将L组受者分为L-L组(GRWR≤3.1%,36例)和L-H组(GRWR>3.1%,87例),将H组受者分为H-L(GRWR≤3.1%,55例)组和H-H组(GRWR>3.1%,10例)。受者和移植物的术后1年存活率分别为92.6%(174/188)和91.0(171/188)。L组受者和移植物的1年存活率分别为94.3%(116/123)和92.7(114/123)。L-L组术后1年存活率为88.9%(32/36),较L-H组的96.6%(84/87)低,差异无统计学意义(P=0.077);L-L组移植物1年存活率为83.3%(30/36),较L-H组的96.6%(84/87)低,差异有统计学意义(P=0.007)。L-L组和L-H组受者术中冷缺血时间分别为479.0(194.0,593.0)min和204.0(122.0,495.0)min,组间比较,差异有统计学意义(P=0.002)。L-L组和L-H组受者术后肝动脉血栓发生率分别为13.9%(5/36)和2.3%(2/87),组间比较,差异有统计学意义(P=0.036)。H组受者1年存活率为89.2%(58/65),移植物1年存活率为87.7%(57/65)。H-L组和H-H组受者术中情况比较,差异均无统计学意义(P值均>0.05)。生存分析结果显示,H-L组受者术后1年存活率为92.7%(51/55),较H-H组70%(7/10)高,差异有统计学意义(P=0.019);H-H组移植物1年存活率为90.9%(50/Objective To explore the effects of graft recipient weight ratio(GRWR)on the early prognosis(within 1 year after operation)of recipients of different ages after split liver transplantation(SLT)in children.Methods From April 2015 to December 2022,the relevant clinical data were retrospectively reviewed for 188 children aged under 12 years undergoing initial SLT.Based upon operative age,they were assigned into groups of L(age≤18 months,123 cases)and H(18 months<age≤12 years,65 cases).Draw receiver operating characteristic(ROC)curves for predicting survival rates in H and L groups using GRWR and determine the cut-off value,and subgroup dassification was based the value.Compare the general condition,intraoperative condition,postoperative condition,and major complications of recipients.Follow-ups were conducted until 12 months post-SLT,death or retransplantation within 12months post-SLT.Kaplan-Meier survival rate analysis was utilized for comparing early postoperative survival rate of recipient/graft.The incidence of major early postoperative complications was examined byχ^(2) test or Fisher exact probability method.Results The survival rate of recipients at Month 12 post-SLT was 92.6%(174/188),and graft survival rate was 91.0%(171/188).The survival rate of recipients in group L at Month 12 post-SLT was 94.3%(116/123),and graft survival rate was 92.7%(114/123).The GRWR value determined of 3.1%.According to the level of GRWR,group L was divided into groups of L-L(GRWR≤3.1%,36 cases)and L-H(GRWR>3.1%,87 cases)while group H groups of H-L(GRWR≤3.1%,55 cases)and H-H(GRWR>3.1%,10 cases).The survival rates of recipients in groups L-L/L-H were 88.9%(32/36)and 96.6%(84/87)at Month 12 post-SLT.Inter-group difference was not statistically significant(P=0.077).Graft survival rates were 83.3%(30/36)and 96.6%(84/87).Inter-group difference was statistically significant(P=0.007).The intraoperative cold ischemia time were 479.0(194.0,593.0)min and 204.0(122.0,495.0)min in groups L-L/L-H.Inter-group difference was statisticall

关 键 词：儿童 劈离式肝移植 移植物受者体重比率 年龄 

分 类 号：R726.5[医药卫生—儿科]