移植物受者体重比率对婴儿全肝移植预后的影响

Impact of graft/recipient weight ratio on the prognosis of infants with whole liver transplantation

目的探讨移植物受者体重比率(GRWR)对1岁以内儿童全肝移植预后的影响。方法回顾性分析2014年1月至2019年12月于天津市第一中心医院1岁以内首次行全肝移植140例儿童受者的临床资料, 根据GRWR值分为三组:低GRWR组(GRWR<2.5%, 48例);中GRWR组(2.5%≤GRWR<5%, 73例);高GRWR组(GRWR≥5%, 19例)。比较三组儿童受者的基本情况, 术后主要并发症的发生率以及移植物和受者存活率。结果本研究共纳入140例儿童受者, 其中男性62例, 女性78例;年龄(7.34±1.81)个月;体重(6.81±1.09)kg;GRWR为3.27%(1.33%~8.12%)。三组间GRWR越高, 其供者的年龄、体重、移植物重量越大, 差异有统计学意义(P<0.05);低GRWR组手术时间、术后ICU停留时间及住院时间较中GRWR组长, 差异有统计学意义(P<0.05);低GRWR组受者术后肝动脉血栓的发生率(31.3%)大于中GRWR组(8.2%), 差异有统计学意义(P<0.05);小肝综合征4例, 均发生在低GRWR组, 与其它两组比较, 差异有统计学意义(P<0.05);低、中、高GRWR组儿童受者术后随访时间为(50.7±23.4)个月, 移植物术后3个月、1年和5年存活率分别为89.6%、91.8%、100%;87.5%、87.7%、100%;87.5%、87.7%、100%, 组间比较差异无统计学意义(P>0.05)。受者术后3个月、1年和5年存活率分别为93.8%、91.8%、100%;91.7%、87.7%、100%;91.7%、87.7%、100%, 组间比较差异无统计学意义(P>0.05)。结论与儿童活体肝移植不同, GRWR≥5%并不影响儿童全肝移植术后受者及移植物存活率, GRWR<2.5%会增加受者术后肝动脉血栓、小肝综合征发生风险。

Objective To explore the impact of graft recipient weight ratio(GRWR)on pediatric whole liver transplantation in infants aged under 1 year.Methods From January 2014 to December 2019,clinical data were retrospectively reviewed for 140 children aged under 1 year with whole liver transplantation.They were divided into 3 groups of low GRWR(GRWR<2.5%,48 cases),middle GRWR(2.5%≤GRWR<5%,73 cases)and high GRWR(GRWR≥5%,19 cases).Basic profiles,major postoperative complications and survival rate of graft/recipient were compared.Results There were 62 males and 78 females with an average age of(7.34±1.81)months and an average weight of(6.81±1.09)kg.The median GRWR was 3.27%(1.33%~8.12%).The higher level of GRWR,the greater age,weight and graft weight of donor in three groups and there was statistical difference(P<0.05);operative duration,postoperative ICU stay and hospital stay were longer in low GRWR group than those in middle GRWR group and there was statistical difference(P<0.05);The incidence of postoperative hepatic artery thrombosis was higher in low GRWR group than that in middle GRWR group(31.3%vs 8.2%)and there was statistical difference(P<0.05);4 cases of small-for-size syndrome occurred in low GRWR group,it was significantly different from the other two groups and there was statistical difference(P<0.05);the median follow-up period was(50.7±23.4)months.The survival rates of grafts at 3-month and 1/5-year were 89.6%,91.8%,100%;87.5%,87.7%,100%;87.5%,87.7%,100%and there was no inter-group difference(P>0.05).The survival rates of recipients at 3 months,1 year and 5 years post-operation were 93.8%,91.8%,100%;91.7%,87.7%,100%;91.7%,87.7%,100%and there was no inter-group difference(P>0.05).Conclusions Different from pediatric living donor transplantation,GRWR≥5%does not affect the survival rate of recipient/graft during whole liver transplantation.And GRWR<2.5%may boost the postoperative incidence of hepatic artery thrombosis and small liver syndrome.