Stephanie Keeling, Malcolm F McDonald, Adrish Anand, Jordan Dunson, Elizabeth Williams, Theodore Zhang, Brian Hickner, Nhu Thao Nguyen Galván, Christine O' Mahony, John A Goss, Abbas Rana
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引用次数: 1
Abstract
Introduction: Pediatric liver transplant recipients have demonstrated excellent long-term survival. The purpose of this analysis is to investigate factors associated with 20-year survival to identify areas for improvement in patient care.
Methods: Kaplan-Meier with log-rank test as well as univariate and multivariate logistic regression methods were used to retrospectively analyze 4,312 liver transplant recipients under the age of 18 between September 30, 1987 and March 9, 1998. Our primary endpoint was 20-year survival among one-year survival.
Results: Logistic regression analysis identified recipient age as a significant risk factor, with recipients below 5 years old having a higher 20-year survival rate (p < 0.001). A preoperative primary diagnosis of a metabolic dysfunction was found to be protective compared to other diagnoses (OR 1.64, CI 1.20-2.25). African-American ethnicity (OR 0.71, CI 0.58-0.87) was also found to be a risk factor for mortality. Technical variant allografts (neither living donor nor cadaveric) were not associated with increased or decreased rates of 20-year survival.
Conclusions: Our analysis suggests that long-term survival is inversely correlated with recipient age following pediatric liver transplant. If validated with further studies, this conclusion may have profound implications on the timing of pediatric liver transplantation.
儿童肝移植受者表现出良好的长期生存。本分析的目的是调查与20年生存率相关的因素,以确定患者护理需要改进的领域。方法:采用Kaplan-Meier、log-rank检验以及单因素和多因素logistic回归方法对1987年9月30日至1998年3月9日期间的4312例18岁以下肝移植受者进行回顾性分析。我们的主要终点是1年生存率中的20年生存率。结果:Logistic回归分析发现受者年龄是一个重要的危险因素,5岁以下受者20年生存率更高(p < 0.001)。与其他诊断相比,术前对代谢功能障碍的初步诊断具有保护作用(OR 1.64, CI 1.20-2.25)。非裔美国人种族(OR 0.71, CI 0.58-0.87)也被发现是死亡率的危险因素。技术变异同种异体移植物(既不是活体供体也不是尸体供体)与20年生存率的增加或降低无关。结论:我们的分析表明,儿童肝移植后的长期生存率与受体年龄呈负相关。如果得到进一步的研究证实,这一结论可能对儿童肝移植的时机有深远的影响。
期刊介绍:
Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery.
The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.