219例胆道闭锁儿童亲属活体肝移植术后临床疗效及其相关因素分析

The clinical analysis of 219 cases of pediatric living-donor liver transplant for biliary atresia

【摘要】目的分析胆道闭锁儿童亲属活体肝移植术后的存活率及相关因素分析。方法对2009年1月到2015年6月期间219例胆道闭锁儿童接受亲属活体肝移植的临床资料进行回顾性分析。分析肝移植术前及术后并发症与预后的关系。采用Kaplan-Meier生存分析方法分析各因素与术后存活率的相关性，组间比较采用Log-rank法；采用Cox比例风险模型进行多因素分析。结果全部儿童受者术后1年和2年的累积存活率分别为94．8％和93．3％。179例年龄≥1岁者术后1年和2年累积存活率分别为94．8％和94．8％，40例年龄〈1岁者分别为94．9％和92．3％，两组比较，差异均无统计学意义（x^2=0．163，P=0．686）。190例移植物重量与受者体重比（GRWR）在1．5％～4．0%之间的受者术后1年和2年累积存活率分别为95．8％和95．8oA，29例GRWR〈1．5％或〉4．0％的受者分别为86．3％和78．80,40，两组比较，差异有统计学意义（Y。=0．163，P=0．686）。多因素Cox回归结果表明，受者术后早期血管并发症、胆道并发症、肺部感染、腹腔积液是预后的影响因素。结论亲属活体肝移植是治疗胆道闭锁的有效手段，可以取得较好的疗效，术后早期并发症是影响胆道闭锁儿童亲属活体肝移植预后的重要因素。

Objective To analyze the clinically related factors and prognosis of living-donor liver transplantation （LDLT） in children with biliary atresia （BA）. Methods Retrospective analyses were performed on 219 BA children undergoing LDLT from January 2009 to June 2015. The relationship between complications and prognosis before and after renal transplantation was analyzed. Cumulative survival was evaluated with Kaplan-Meier method, and differences in survival between groups were evaluated with log-rank test. Multivariable factors associated with patient survival were analyzed with Cox proportional hazards regression model. Results The overall 1- and 2-year cumulative survival rate for recipients was 94. 8% and 93.3% respectively. For the recipients aged 1 year, the 1- and 2-year cumulative survival rate were 94. 8% and 94. 8% respectively, and for those aged 〈1 year, the 1- and 2-year cumulative survival rate was 94. 9% and 92. 3% respectively. No significant inter-group differences existed （x^2 = 0. 163, P = 0. 686）. For recipients receiving grafts with graft-to-recipient body weight ratio （GRWR） ranging from 1.5% to 4. 0% （190 recipients）, the 1-and 2-year cumulative survival rate was 95. 8% and 95.8% respectively, and for those from 1.5%/〉4. 0 （29 recipients）, the 1- and 2-year cumulative survival rate was 86. 3% and 78.8% respectively. Significant inter-group differences existed （x^2 = 7. 881, P = 0. 005）. Multivariable Cox results showed that early post-LT complications included vascular complications, biliary complications, pulmonary infection and ascites, which were the influencing factors of prognosis. Conclusion As an effective treatment, LDLT in BA children has achieved satisfactory outcomes. Early post-LT complications were the influencing factors of prognosis.