Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease:A retrospective observational study

作     者：Amr M Alnagar Abdul R Hakeem Khaled Daradka Eirini Kyrana Marumbo Methga KarthikeyanPalaniswamy Sanjay Rajwal Jamila Mulla Moira O'meara Vivek Upasani Dhakshinamoorthy Vijayanand Raj Prasad Magdy S Attia 

作者机构：Department of General SurgeryFaculty of MedicineAlexandria UniversityAlexandria 21615Egypt Liver and Transplant SurgeryThe Leeds Teaching HospitalsNHS Foundation TrustLeeds LS97TFUnited Kingdom 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2023年第13卷第3期

页      面：96-106页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Pediatric liver transplantation Acute liver failure End-stage chronic liver disease Graft failure Patient survival Complications 

摘      要：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 *** liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two *** To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in *** This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and *** and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient *** 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 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 ***-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 *** the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.