Diamond IR, Fecteau A, Millis JM, Losanoff JE, Ng V, Anand R, Song C; SPLIT研究小组.
儿科多器官移植计划，病童医院，多伦多，加拿大

目标：研究全器官肝移植新技术在小儿肝移植受体中的功效。

背景：肝移植新技术包括劈裂式肝移植、减体积肝移植和活体肝移植，以满足小儿受体的特殊需要（移植时间和适当的移植体积等）。

方法：分析来自小儿肝移植研究（SPLIT）登记处的数据，该登记处是一个含44个北美小儿肝移植项目的多中心数据库。每一项肝移植新技术的结果（发病率和死亡率）都与全器官移植受体进行了比较。

结果：移植受体的有效数据共2192例（1183例全器官移植、261例劈裂式肝移植、388例减体积肝移植和360例活体肝移植）。与全器官受体相比，接受新移植类型的受体明显更年轻，且在移植候选名单上平均少等待2.3个月。移植术后30天以内的发病率随着与全器官相关的新技术而增加（45.1%全器官、66.7%劈裂式、65.5%减体积、51.9%活体肝移植），其中胆道并发症（30天：7.5%全器官、18.8%劈裂式、16%减体积、17.5%活体肝移植）和门静脉血栓（30天：3.6%全器官、8%劈裂式、8%减体积、7.5%活体肝移植）更为常见。多元分析法显示，移植类型是移植物功能不全（死亡或再次移植）的独立预测指标。与全器官受体相比，劈裂式和减体积肝移植（相对风险指数分别为1.74和1.77）的效果更差。

结论：移植新技术扩大了儿科捐赠者的范围，缩短了移植等待时间，但同时也导致了发病率和死亡率的上升。

PMID: 17667510 [PubMed - indexed for MEDLINE]

Impact of graft type on outcome in pediatric liver transplantation: a report From Studies of Pediatric Liver Transplantation (SPLIT).

Diamond IR, Fecteau A, Millis JM, Losanoff JE, Ng V, Anand R, Song C; SPLIT Research Group.Pediatric Academic Multiorgan Transplant Program, The Hospital for Sick Children, Toronto, Canada.

　　OBJECTIVE: To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients.

BACKGROUND: Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need for timely and size appropriate grafts for pediatric recipients.

METHODS: Analysis of data from the Studies of Pediatric Liver Transplantation (SPLIT) registry, a multicenter database of 44 North American pediatric liver transplant programs. The outcome (morbidity and mortality) of each of the technical variants were compared with that of whole organ recipients.

RESULTS: Data were available on 2192 transplant recipients (1183 whole, 261 split, 388 reduced, and 360 live donor). Recipients of all technical variant graft type were significantly younger than whole organ recipients, but on average spent 2.3 months less on the waiting list. Thirty-day post-transplant morbidity was increased for each type of technical variant relative to whole organ (45.1% whole, 66.7% split, 65.5% reduced, 51.9% live-donor). Biliary complications (30 day: 7.5% whole, 18.8% split, 16% reduced, 17.5% live-donor) and portal vein thrombosis (30 day: 3.6% whole, 8% split, 8% reduced, 7.5% live-donor) were more common in all technical variant types. Graft type was an independent predictor of graft loss (death or retransplantation) in a multivariate analysis. Split and reduced (relative risk = 1.74 and 1.77, respectively) grafts had a worse outcome when compared with whole organ recipients.

CONCLUSIONS: Technical variant techniques expand the pediatric donor pool and reduce time from listing to transplant, but they are associated with increased morbidity and mortality.

PMID: 17667510 [PubMed - indexed for MEDLINE]

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