背景:本研究的目的是比较小儿LT与左肝移植的结局,从活体捐献者(LD)或分裂的已故捐献者(sDD)获得。
方法:2002年至2022年的回顾性单中心研究。包括来自LD或sDD的所有具有左肝移植物(不包括肝中静脉)的小儿LT。不包括减少的移植物。
结果:共进行了112例小儿LT:58例使用LD移植物,54例使用sDD移植物(17例非原位分裂,37例原位移植)。捐赠者特征相似,除了捐赠者年龄(LD与LD的33岁在sDD的30年,p=0.03)。适应症相似,每组有55%的胆道闭锁。sDD组的再移植频率更高(2%vs.15%,p=0.01)。收件人年龄,体重,移植时PELD评分在组间无显著差异。sDD的冷缺血时间更长(LD中158分钟与在sDD中390分钟;p<0.0001)。sDD移植物移植后ALT峰值较高(1470vs.1063,p=0.018),sDD移植的住院时间更长(27vs.21天,p=0.005)。然而,在主要发病率(Dindo-Clavien等级≥3)方面,组间没有差异,血管和胆道并发症,90天死亡率。患者在10年时的生存率为LD的93.1%和sDD的92.8%(p=0.807)。10年时,LD的移植物存活率为89.7%,sDD的移植物存活率为83.1%(p=0.813)。
结论:技术上相似的LD和sDD移植物获得了非常相似的术后和长期结局,患者和移植物存活良好。
BACKGROUND: The aim of the present study was to compare the outcomes of pediatric LT with left liver grafts, obtained either from a living donor (LD) or a split deceased donor (sDD).
METHODS: Retrospective single-center study from 2002 to 2022. All pediatric LT with left liver grafts (not including middle hepatic vein) from LD or sDD were included. Reduced grafts were not included.
RESULTS: A total of 112 pediatric LT were performed: 58 with LD grafts and 54 with sDD grafts (17 split ex situ and 37 in situ). Donor characteristics were similar, apart from donor age (33 years in LD vs. 30 years in sDD, p = 0.03). Indications were similar with 55% biliary atresia in each group. Retransplantation was more frequently performed in the sDD group (2% vs. 15%, p = 0.01). Recipient age, weight, and PELD score at transplant were not significantly different between groups. Cold ischemia time was longer for sDD (158 min in LD vs. 390 min in sDD; p < 0.0001). Posttransplant peak ALT was higher with sDD grafts (1470 vs. 1063, p = 0.018), and hospital stay was longer with sDD grafts (27 vs. 21 days, p = 0.005). However, there was no difference between groups in terms of major morbidity (Dindo-Clavien grade ≥3), vascular and biliary complications, and 90-day mortality. Patient survival at 10 years was 93.1% for LD and 92.8% for sDD (p = 0.807). Graft survival at 10 years was 89.7% for LD and 83.1% for sDD (p = 0.813).
CONCLUSIONS: Technically similar LD and sDD grafts achieve very similar postoperative and long-term outcomes with excellent patient and graft survival.