Amr M Alnagar, Abdul R Hakeem, Khaled Daradka, Eirini Kyrana, Marumbo Methga, Karthikeyan Palaniswamy, Sanjay Rajwal, Jamila Mulla, Moira O'meara, Vivek Upasani, Dhakshinamoorthy Vijayanand, Raj Prasad, Magdy S Attia
{"title":"儿童肝移植治疗急性肝衰竭与终末期慢性肝病的长期疗效:一项回顾性观察性研究","authors":"Amr M Alnagar, Abdul R Hakeem, Khaled Daradka, Eirini Kyrana, Marumbo Methga, Karthikeyan Palaniswamy, Sanjay Rajwal, Jamila Mulla, Moira O'meara, Vivek Upasani, Dhakshinamoorthy Vijayanand, Raj Prasad, Magdy S Attia","doi":"10.5500/wjt.v13.i3.96","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Children with acute liver failure (ALF) who meet the criteria are eligible for super-urgent transplantation, whereas children with end-stage chronic liver disease (ESCLD) are usually transplanted electively. Pediatric liver trans plantation (PLT) in ALF and ESCLD settings has been well described in the literature, but there are no studies comparing the outcomes in these two groups.</p><p><strong>Aim: </strong>To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.</p><p><strong>Methods: </strong>This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019. ALF and ESCLD groups were compared for pretransplant recipient, donor and operative parameters, and post-operative outcomes including graft and patient survival.</p><p><strong>Results: </strong>Over a 20-year study period, 232 primary PLTs were performed at our center; 195 were transplanted for ESCLD and 37 were transplanted for ALF. The ALF recipients were significantly older (median 8 years <i>vs</i> 5.4 years; <i>P</i> = 0.031) and heavier (31 kg <i>vs</i> 21 kg; <i>P</i> = 0.011). Living donor grafts were used more in the ESCLD group (34 <i>vs</i> 0; <i>P</i> = 0.006). There was no difference between the two groups concerning vascular complications and rejection, but there were more bile leaks in the ESCLD group. Post-transplant patient survival was significantly higher in the ESCLD group: 1-, 5-, and 10-year survival rates were 97.9%, 93.9%, and 89.4%, respectively, compared to 78.3%, 78.3%, and 78.3% in the ALF group (<i>P</i> = 0.007). However, there was no difference in 1-, 5-, and 10-year graft survival between the ESCLD and ALF groups (90.7%, 82.9%, 77.3% <i>vs</i> 75.6%, 72.4%, and 66.9%; <i>P</i> = 0.119).</p><p><strong>Conclusion: </strong>Patient survival is inferior in ALF compared to ESCLD recipients; the main reason is death in the 1<sup>st</sup> year post-PLT in ALF group. Once the ALF children overcome the 1<sup>st</sup> year after transplant, their survival stabilizes, and they have good long-term outcomes.</p>","PeriodicalId":68893,"journal":{"name":"世界移植杂志(英文版)","volume":"13 3","pages":"96-106"},"PeriodicalIF":0.0000,"publicationDate":"2023-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/86/11/WJT-13-96.PMC10037232.pdf","citationCount":"0","resultStr":"{\"title\":\"Long-term outcomes of pediatric liver transplantation in acute liver failure <i>vs</i> end-stage chronic liver disease: A retrospective observational study.\",\"authors\":\"Amr M Alnagar, Abdul R Hakeem, Khaled Daradka, Eirini Kyrana, Marumbo Methga, Karthikeyan Palaniswamy, Sanjay Rajwal, Jamila Mulla, Moira O'meara, Vivek Upasani, Dhakshinamoorthy Vijayanand, Raj Prasad, Magdy S Attia\",\"doi\":\"10.5500/wjt.v13.i3.96\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Children with acute liver failure (ALF) who meet the criteria are eligible for super-urgent transplantation, whereas children with end-stage chronic liver disease (ESCLD) are usually transplanted electively. Pediatric liver trans plantation (PLT) in ALF and ESCLD settings has been well described in the literature, but there are no studies comparing the outcomes in these two groups.</p><p><strong>Aim: </strong>To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.</p><p><strong>Methods: </strong>This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019. ALF and ESCLD groups were compared for pretransplant recipient, donor and operative parameters, and post-operative outcomes including graft and patient survival.</p><p><strong>Results: </strong>Over a 20-year study period, 232 primary PLTs were performed at our center; 195 were transplanted for ESCLD and 37 were transplanted for ALF. The ALF recipients were significantly older (median 8 years <i>vs</i> 5.4 years; <i>P</i> = 0.031) and heavier (31 kg <i>vs</i> 21 kg; <i>P</i> = 0.011). Living donor grafts were used more in the ESCLD group (34 <i>vs</i> 0; <i>P</i> = 0.006). There was no difference between the two groups concerning vascular complications and rejection, but there were more bile leaks in the ESCLD group. Post-transplant patient survival was significantly higher in the ESCLD group: 1-, 5-, and 10-year survival rates were 97.9%, 93.9%, and 89.4%, respectively, compared to 78.3%, 78.3%, and 78.3% in the ALF group (<i>P</i> = 0.007). However, there was no difference in 1-, 5-, and 10-year graft survival between the ESCLD and ALF groups (90.7%, 82.9%, 77.3% <i>vs</i> 75.6%, 72.4%, and 66.9%; <i>P</i> = 0.119).</p><p><strong>Conclusion: </strong>Patient survival is inferior in ALF compared to ESCLD recipients; the main reason is death in the 1<sup>st</sup> year post-PLT in ALF group. Once the ALF children overcome the 1<sup>st</sup> year after transplant, their survival stabilizes, and they have good long-term outcomes.</p>\",\"PeriodicalId\":68893,\"journal\":{\"name\":\"世界移植杂志(英文版)\",\"volume\":\"13 3\",\"pages\":\"96-106\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-03-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/86/11/WJT-13-96.PMC10037232.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"世界移植杂志(英文版)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5500/wjt.v13.i3.96\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"世界移植杂志(英文版)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5500/wjt.v13.i3.96","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:符合标准的急性肝衰竭(ALF)儿童有资格进行超紧急移植，而终末期慢性肝病(ESCLD)儿童通常是选择性移植。小儿肝移植(PLT)在ALF和ESCLD环境中已经在文献中有很好的描述，但没有研究比较这两组的结果。目的:确定ALF和ESCLD在PLT术后并发症和生存结局方面是否存在差异。方法:这是一项回顾性观察研究，纳入了2000年至2019年在单一中心进行的所有原发性plt。ALF组和ESCLD组比较移植前受体、供体和手术参数，以及术后结果，包括移植物和患者生存。结果:在20年的研究期间，我们中心进行了232例原发性plt;ESCLD移植195例，ALF移植37例。ALF受者明显变老(中位8岁vs 5.4岁;P = 0.031)和更重(31公斤vs 21公斤;P = 0.011)。ESCLD组使用活体供体移植物较多(34 vs 0;P = 0.006)。两组在血管并发症和排斥反应方面没有差异，但ESCLD组有更多的胆汁泄漏。ESCLD组移植后患者生存率显著提高:1年、5年和10年生存率分别为97.9%、93.9%和89.4%，而ALF组为78.3%、78.3%和78.3% (P = 0.007)。然而，ESCLD组和ALF组的1、5和10年移植物存活率没有差异(90.7%、82.9%、77.3% vs 75.6%、72.4%和66.9%;P = 0.119)。结论:与ESCLD患者相比，ALF患者的生存率较低;ALF组以术后1年死亡为主。一旦ALF儿童克服了移植后的第一年，他们的生存就稳定下来，并且他们有良好的长期预后。
Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease: A retrospective observational study.
Background: Children with acute liver failure (ALF) who meet the criteria are eligible for super-urgent transplantation, whereas children with end-stage chronic liver disease (ESCLD) are usually transplanted electively. Pediatric liver trans plantation (PLT) in ALF and ESCLD settings has been well described in the literature, but there are no studies comparing the outcomes in these two groups.
Aim: To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.
Methods: This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019. ALF and ESCLD groups were compared for pretransplant recipient, donor and operative parameters, and post-operative outcomes including graft and patient survival.
Results: Over a 20-year study period, 232 primary PLTs were performed at our center; 195 were transplanted for ESCLD and 37 were transplanted for ALF. The ALF recipients were significantly older (median 8 years vs 5.4 years; P = 0.031) and heavier (31 kg vs 21 kg; P = 0.011). Living donor grafts were used more in the ESCLD group (34 vs 0; P = 0.006). There was no difference between the two groups concerning vascular complications and rejection, but there were more bile leaks in the ESCLD group. Post-transplant patient survival was significantly higher in the ESCLD group: 1-, 5-, and 10-year survival rates were 97.9%, 93.9%, and 89.4%, respectively, compared to 78.3%, 78.3%, and 78.3% in the ALF group (P = 0.007). However, there was no difference in 1-, 5-, and 10-year graft survival between the ESCLD and ALF groups (90.7%, 82.9%, 77.3% vs 75.6%, 72.4%, and 66.9%; P = 0.119).
Conclusion: Patient survival is inferior in ALF compared to ESCLD recipients; the main reason is death in the 1st year post-PLT in ALF group. Once the ALF children overcome the 1st year after transplant, their survival stabilizes, and they have good long-term outcomes.
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