儿童活体和尸体肝移植的临床效果比较

Comparison of clinical effects between pediatric living donor liver transplantation and deceased donor liver transplantation

目的分析和评价儿童活体和尸体肝移植的效果.方法回顾性分析320 例终末期肝病儿童肝移植的预后及影响因素.根据肝移植手术方式的不同,将320 例受者分为活体肝移植组（活体组）252 例和尸体肝移植组（尸肝组）68 例.活体组所有供者均为3 代以内的直系亲属;尸肝组所有供者均为心脏死亡或脑死亡供者.比较两组受者术后存活情况和并发症情况.结果活体组受者1、2、3 年的总体存活率分别为95.1%、93.5%和93.5%,尸肝组分别为92.3%、92.3%和82.4%,两组间比较差异无统计学意义（Log-rank χ2=0.69,P=0.41）.随访期间,活体组死亡14 例（5.56%）,其中8 例死于呼吸系统并发症,3 例死于多器官功能衰竭,3 例死于移植肝功能衰竭;尸肝组死亡5 例（7.35%）,其中1 例死于呼吸系统并发症,2 例死于多器官功能衰竭,1 例死于腹腔出血,1 例死于其他原因.两组门静脉血栓（PVT）、流出道梗阻、胆道并发症、肺部感染差异无统计学意义（均P〉0.05）,活体组肝动脉血栓（HAT）比例低于尸肝组（1.98% vs. 10.29%,χ^2=10.245,P 〈 0.01）.结论活体肝移植作为治疗终末期肝病的有效手段,疗效较好.

Objective To analyze and evaluate the efficacy of living donor liver transplantation (LDLT) and deceased <br> donor liver transplantation (DDLT). Methods The clinical data of prognosis and influencing factors of 320 children with liver transplantation were analyzed retrospectively. The 320 children were divided into LDLT group (n=252) and DDLT group (n=68) based on their operation styles. In LDLT group, all donors to recipients were immediate relatives within three generation. In DDLT group, all livers were obtained from cardiac death or brain death donors. The survival and incidence of complications were observed between two groups. Results The 1-year, 2-year and 3-year cumulative survival rates for recipients were 95.1%, 93.5% and 93.5% in LDLT group, and 92.3%, 92.3% and 82.4% in LDLT group. There was no significant difference between the two groups (Log-rank χ2=0.69,P=0.41). During the follow-up period,14 cases died (5.56%) in LDLT group, in which 8 deaths due to respiratory complication, 3 deaths due to multiple organ failure, and 3 deaths due to graft failure. In DDLT donor group, 5 cases died (7.35%), in which 1 death due to respiratory complication, 2 deaths due to multiple organ failure, 1 death due to intra-abdominal hemorrhage, and 1 case of unknown cause of death. There were no significant differences in portal vein thrombosis (PVT), outflow tract obstruction, biliary tract complications and pulmonary infection between the two groups (P>0.05). The ratio of hepatic artery thrombosis (HAT) was lower in LDLT group than that of DDLT group (1.98%vs. 10.29%,χ2=10.245,P<0.01). Conclusion Living donor liver transplantation is an effective method to treat end-stage liver disease.