小月龄供肝在儿童肝移植中的应用

Application of liver graft from little-month-old donors in liver transplantation for children

目的探讨小月龄供肝在儿童肝移植中的可行性和安全性。方法回顾性分析2014年1月至2016年12月天津市第一中心医院接受器官捐献的101例儿童肝移植供者和受者临床资料。受者男46例,女55例;月龄5.8~40.5个月,中位月龄9.0个月。根据供者月龄,将受者分为极小月龄组(26例)、小月龄组(22例)和正常月龄组(53例)。供受者家属均签署知情同意书,符合医学伦理学规定。对受者围手术期情况、术后并发症以及移植物和受者生存率进行比较分析。率的比较采用χ^2检验或Fisher确切概率法。生存分析采用Log-rank检验。结果极小月龄组肝动脉血栓形成发生率38%(10/26),明显高于正常月龄组的13%(7/53)(χ^2=6.6,P<0.017)。极小月龄组术后小肝综合征发生率23%(6/26),小月龄组和正常月龄组无发生,差异有统计学意义(P<0.05)。极小月龄组急性排斥反应发生率为4%(1/26),明显低于小月龄组的27%(6/22)(χ^2=5.3,P<0.017)。3组术后3年移植物存活率分别为88.5%、95.5%和90.6%,差异无统计学意义(χ^2=0.4,P>0.05)。3组受者术后3年累积生存率分别为92.3%、95.5%和94.3%,差异无统计学意义(χ^2=0.2,P>0.05)。结论小月龄供肝移植物可安全用于经过严格筛选的儿童肝移植受者,受者动脉血栓形成和小肝综合征发生率高,但总体生存无影响,且具有一定的免疫耐受优势。

Objective To investigate the feasibility and safety of liver graft from little-monthold donors in pediatric liver transplantation.Methods Clinical data of 101 donors and recipients undergoing liver transplantation from January 2014 to December 2016 in Tianjin First Central Hospital were retrospectively analyzed.46 recipients were male and 55 female,aged 5.8-40.5 months with a median age of 9.0 months.According to the age of donors,all recipients were divided into the extremely little-month-old group(n=26),little-month-old group(n=22)and normal-month-old group(n=53).The informed consents of all parents of donors were obtained and the local ethical committee approval was received.The perioperative conditions,postoperative complications and survival rate of grafts and recipients were statistically compared and analyzed.The rate comparison was conducted by Chi-square test or Fisher's exact probability test.The survival analysis was performed by Log-rank test.Results The incidence of hepatic arterial thrombosis in the extremely little-month-old group was 38%(10/26),significantly higher than 13%(7/53)in the normalmonth-old group(χ^2=6.6,P<0.017).The incidence of postoperative small-for-size syndrome was 23%(6/26)in the extremely little-month-old group,significantly higher than 0 in the little-month-old and normal-monthold groups(P<0.05).In the extremely little-month-old group,the incidence of acute rejection was 4%(1/26),significantly lower than 27%(6/22)in the little-month-old group(χ^2=5.3,P<0.017).The 3-year survival rates of liver graft in 3 groups were 88.5%,95.5%and 90.6%,respectively,and no significant difference was observed(χ^2=0.4,P>0.05).The 3-year cumulative survival rates of the recipients in three groups were 92.3%,95.5%and 94.3%,respectively,and no significant difference was observed(χ^2=0.2,P>0.05).Conclusions Under strict selection,the liver graft from little-month-old donors can be safely used in pediatric liver transplantation.The incidence of arterial thrombosis and small-for-size syndrome in the recipients is high,however,the overall survival is not affected.Besides,it possesses the advantage of immune tolerance.