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An analysis of postoperative complications in children with biliary atresia after liver transplantation
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摘要: 目的分析肝移植治疗胆道闭锁患儿术后并发症及预后。方法回顾性分析2006年6月-2014年4月于重庆医科大学附属儿童医院完成初次肝移植的41例胆道闭锁患儿临床资料,其中活体肝移植28例,心脏死亡器官捐献（DCD）供肝肝移植13例。活体与DCD肝移植受者术后随访时间分别为6790个月和1556个月,总结围手术期及随访期并发症发生情况及预后。计数资料组间比较采用Fisher’s精确概率法。结果 41例肝移植受者围手术期并发症包括:血管并发症、腹腔出血、肠穿孔、排斥反应、感染并发症等。DCD肝移植组肝动脉栓塞（HAT）的发生率明显高于活体肝移植组（P=0.02）。围手术期死亡10例,其中活体肝移植组4例,包括HAT 1例;因HAT再次行DCD肝移植1例,后因原发肝无功能死亡;呕吐窒息1例;多器官功能衰竭1例。DCD肝移植死亡6例,包括HAT 1例;肺部肺炎克雷伯杆菌感染1例;肠漏后感染性休克1例;循环衰竭1例;严重毛细血管渗漏综合征1例;原发肝无功能1例。随访期活体肝移植死亡4例,包括肝静脉狭窄2例;胆道感染1例;胆道狭窄1例。DCD肝移植随访期间未...Abstract: Objective To investigate the postoperative complications and prognosis of children with biliary atresia treated with liver transplantation.Methods A retrospective analysis was performed for the clinical data of 41 children with biliary atresia who underwent primary liver transplantation in The Affiliated Children's Hospital of Chongqing Medical University from June 2006 to April 2014.Among these children,28 underwent living donor liver transplantation( LDLT) and 13 underwent liver transplantation from donation after cardiac death( DCD) donors.The children undergoing LDLT or DCD liver transplantation were followed up for 67- 90 months and 15- 56 months,respectively.The complications in the perioperative period and follow- up and prognosis were analyzed.The Fisher's exact test was used for comparison of categorical data between groups.Results Perioperative complications mainly included vascular complications,intra- abdominal hemorrhage,intestinal perforation,rejection reaction,and infection.The incidence of hepatic artery thrombosis in DCD groups was significantly higher than LDLT groups( P = 0.02).A total of 10 children died in the perioperative period,among whom 4 underwent LDLT( 1died of hepatic artery thrombosis,1 underwent DCD liver transplantation due to hepatic artery thrombosis and later died of primary graft failure,1 died of suffocation caused by vomiting,and 1 died of multiple organ failure) and 6 underwent DCD liver transplantation( 1 child each died of hepatic artery thrombosis,pulmonary Klebsiella pneumoniae infection,septic shock after intestinal leakage,circulatory failure,severe capillary leak syndrome,and primary graft failure).During the follow- up,4 children undergoing LDLT died,among whom 2 died of hepatic vein stenosis,1 died of biliary tract infection,and 1 died of biliary stricture.No children undergoing DCD liver transplantation died or experienced complications during follow- up.Conclusion Various complications after liver transplantation in children with biliary atresia are important factors affecting the success rate of liver transplantation and long- term survival rates.Early prevention,early diagnosis,and timely treatment are very important to improve the prognosis of children undergoing liver transplantation.
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Key words:
- liver transplantation /
- biliary atresia /
- postoperative complications /
- child
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[1]MALHOTRA S,SIBAL A,BHATIA V,et al.Living related liver transplantation for biliary atresia in the last 5 years:experience from the first liver transplant program in India[J].Indian J Pediatr,2015,82(10):884-889. [2]CHEN YJ,LI WF,ZHANG TC,et al.Precise procedure of Kasai operation in biliary atresia[J].J Appl Clin Pediatr,2013,28(11):832-834.(in Chinese)陈亚军,李万福,张廷冲,等.胆道闭锁Kasai手术的精准处理[J].中华实用儿科临床杂志,2013,28(11):832-834. [3]BIJL EJ,BHARWANI KD,HOUWEN RH,et al.The long-term outcome of the Kasai operation in patients with biliary atresia:a systematic review[J].Neth J Med,2013,71(4):170-173. [4]TESSIER ME,HARPAVAT S,SHEPHERD RW,et al.Beyond the pediatric end-stage liver disease system:solutions for infants with biliary atresia requiring liver transplant[J].World J Gastroenterol,2014,20(32):11062-11068. [5]WANG L,ZHANG MM,REN ZM,et al.Application of cyclosporine A in children after living donor liver transplantation:an analysis of 17 cases[J].J Third Milit Med Univ,2014,36(17):1864-1865.(in Chinese)王磊,张明满,任志美,等.17例儿童活体肝移植术后环孢素A使用分析[J].第三军医大学学报,2014,36(17):1864-1865. [6]FRONGILLO F,LIROSI MC,NURE E,et al.Diagnosis and management of hepatic artery complications after liver transplantation[J].Transplant Proc,2015,47(7):2150-2155. [7]MATHUR AK,HEIMBACH J,STEFFICK DE,et al.Donation after cardiac death liver transplantion:predictors of outcome[J].Am J Transplant,2010,10(11):2512-2519. [8]ZHENG ZG,ZHU ZJ,SUN LY,et al.Applications of liver grafts from donation after cardiac death children in pediatric liver transplantation:22 cases report[J].Chin J Organ Transplant,2014,35(6):350-352.(in Chinese)曾志贵,朱志军,孙丽莹,等.儿童器官捐赠供肝在儿童肝移植中的应用22例[J].中华器官移植杂志,2014,35(6):350-352. [9]SANADA Y,MIZUTA K,WAKIYA T,et al.Bowel perforation after pediatric living donor liver transplantation[J].Pediatr Surg Int,2011,27(1):23-27. [10]NETO JS,FEIER FH,BIERRENBACH AL,et al.Impact of Kasai portoenterostomy on liver transplantation outcomes:a retrospective cohort study of 347 children with biliary atresia[J].Liver Transpl,2015,21(7):922-927. [11]FEIER FH,SEDA-NETO J,da FONSECA EA,et al.Analysis of factors associated with biliary complications in children after liver transplantation[J].Transplantation,2016,100(9):1944-1954. [12]MIRAGLIA R,MARUZZELLI L,CARUSO S,et al.Minimally invasive endovascular and biliary treatments of children with acute hepatic artery thrombosis following liver transplantation[J].Pediatr Radiol,2014,44(1):94-102. [13]RYU CH,LEE SK.Biliary strictures after liver transplantation[J].Gut Liver,2011,5(2):133-142. [14]MIYAZAKI M,ISODA H.Non-contrast-enhanced MR angiography of the abdomen[J].Eur J Radiol,2011,80(1):9-23. [15]WEN F,LU ZM,ZHANG J,et al.Interventional treatment for recurrent obstructive jaundice after biliary-intestinal anastomosis[J].Chin J Med Imaging,2012,20(6):462-464.(in Chinese)温锋,卢再鸣,张军,等.胆肠吻合术后再发梗阻性黄疸的介入治疗[J].中国医学影像学杂志,2012,20(6):462-464. -
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