移植物体重比对胆道闭锁婴儿活体肝移植术后疗效的影响

Analysis of the impact of graft to recipient body weight ratio on the efficacy of living donor liver transplantation in infants with biliary atresia

目的探讨移植物体重比(GRWR)对婴儿期胆道闭锁(BA)患儿活体肝移植(LDLT)术后疗效的影响。方法回顾性分析2018年5月至2022年12月于重庆医科大学附属儿童医院肝胆外科接受亲属LDLT的175例BA婴儿的临床资料,其中男性98例,女性77例,移植时月龄为5.40(4.77,6.33)个月。根据GRWR将患儿分为两组:2%≤GRWR≤4%的患儿纳入常规GRWR组(n=121);GRWR>4%的患儿纳入高GRWR组(n=54)。比较两组患儿术前一般情况、术中情况及术后恢复情况。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。结果LDLT术后共有16例(9.14%,16/175)患儿非计划再次手术。常规GRWR组和高GRWR组患儿的移植时体重和移植物重量组间差异均具有统计学意义(均P<0.05)。两组患儿的手术时间、术中出血量、术后并发症发生率组间差异均无统计学意义(均P>0.05)。两组患儿术后均无肝动脉血栓或狭窄发生。常规GRWR组患儿术后1、3年的累积生存率分别为97.5%和95.5%,高GRWR组患儿术后1、3年的累积生存率分别96.3%和94.2%,两组患儿的累积生存率差异无统计学意义(P=0.692)。结论使用GRWR>4%的肝移植物对于婴儿期BA患儿行LDLT亦安全有效,提示对于高GRWR患儿可能无需采用减少移植肝体积方式进行活体肝移植。

ObjectiveTo explore the effects of different graft to recipient body weight ratio(GRWR)on the efficacy of living donor liver transplantation(LDLT)in infants with biliary atresia(BA).MethodsClinical data of 175 BA infants,including 98 males and 77 females,age at transplantation was 5.40(4.77,6.33)months,who underwent LDLT at the Department of Hepatobiliary Surgery,Children’s Hospital of Chongqing Medical University from May 2018 to December 2022 were retrospectively analyzed.They were divided into the routine GRWR group(2%≤GRWR≤4%,n=121)and high GRWR group(GRWR>4%,n=54).The preoperative general condition,intraoperative condition and postoperative recovery of children in the two groups were compared.Survival analysis was performed by using Kaplan-Meier method,and log-rank test was used to compare survival differences.ResultsA total of 16(9.14%,16/175)children underwent unplanned surgery after LDLT.There were statistically significant differences in weight at LDLT and graft weight between children in the routine GRWR and high GRWR groups(both P<0.05).There were no statistically significant difference between the two groups in terms of operative time,intraoperative bleeding,and postoperative complication rates(all P>0.05).There were no hepatic artery thrombosis or stenosis occurred in the children of both groups after LDLT.The cumulative survival rates of the children in the routine GRWR group were 97.5%and 95.5%at 1 and 3 years after LDLT,respectively,and 96.3%and 94.2%at 1 and 3 years after LDLT in the high GRWR group,and the difference in cumulative survival rates between the two groups was not statistically significant(P=0.692).ConclusionThe use of liver grafts with GRWR>4%is also safe and effective for LDLT in infants with BA,which supposes that may not be necessary to reduce the transplanted liver volume in children LDLT with high GRWR.