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Development and validation of a nomogram to predict allograft survival after pediatric liver transplantation

World Journal of pediatrics 2024年第3期20卷 239-249页

作者： Guang-Xiang Gu Shu-Ting Pan Yi-Chen Fan Chen Chen Qiang Xia Department of liver Surgery Renji HospitalShanghai Jiaotong University School of MedicineNo.160 Pujian RoadPudong New DistrictShanghai 200128China Department of liver transplantation Sun Yet-Sen Memorial HospitalSun Yat-Sen UniversityNo.107 Yanjiang West RoadGuangzhou 510080China Clinical Center for Investigation Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina Department of Anesthesiology Renji HospitalShanghai Jiaotong University School of MedicineShanghaiChina

Background liver transplantation is the main treatment for cholestatic liver disease and some metabolic liver diseases in ***,no accurate prediction model to determine the survival probability of grafts prior to surgery *** study aimed to develop an effective prognostic model for allograft survival after pediatric liver *** This retrospective cohort study included 2032 patients who underwent pediatric liver transplantation between January 1,2006,and January 1,2020.A nomogram was developed using Cox regression and validated based on bootstrap *** and discriminatory accuracies were determined using the concordance index and visualized using calibration curves;net benefits were calculated for model *** online Shiny application was developed for easy access to the *** Multivariable analysis demonstrated that preoperative diagnosis,recipient age,body weight,graft type,preoperative total bilirubin,interleukin-1β,portal venous blood flow direction,spleen thickness,and the presence of heart disease and cholangitis were independent factors for survival,all of which were selected in the *** of the nomogram indicated that the 1-,3-,and 5-year predicted survival rates agreed with the actual survival *** concordance indices for graft survival at 1,3,and 5 years were 0.776,0.757,and 0.753,respectively,which were significantly higher than those of the pediatric End-Stage liver Disease and Child-Pugh scoring *** allograft dysfunction risk of a recipient could be easily predicted using the following URL:https://***/ASPELT/l Conclusion The allograft survival after pediatric liver transplantation(ASPELT)score model can effectively predict the graft survival rate after liver transplantation in children,providing a simple and convenient evaluation method for clinicians and patients.

关键词： Allograft survival Nomogram pediatric liver transplantation

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pediatric liver transplantation in 31 consecutive children

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Chinese Medical Journal 2008年第20期121卷 2001-2003页

作者： SHEN Zhong-yang WANG Zi-fa ZHU Zhi-jun ZANG Yun-jin ZHENG Hong DENG Yong-lin PAN Cheng CHEN Xin-guo liver transplantation Institute General Hospital of Chinese People's Armed Police Force Beijing 100039 China Oriental Organ transplantation Center Tianjin First Central Hospital Tianjin 300192 China

Background Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements. Methods Thirty-one children （≤18 years old） underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old （ranged from 5 months to 18 years） with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson＇s disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard （without venovenous bypass）, 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug （FK506, steroid, and mycophenolate mofetil） immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months. Results Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus （HBV） or hepatitis C virus （HCV） infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively. Conclusions The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients＇ age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. pediatric liver transplantation especially requires higher su

关键词： pediatric liver transplantation indications complications

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

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World Journal of transplantation 2023年第3期13卷 96-106页

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 Department of General Surgery Faculty of MedicineAlexandria UniversityAlexandria 21615Egypt liver and Transplant Surgery The Leeds Teaching HospitalsNHS Foundation TrustLeeds LS97TFUnited Kingdom

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.

关键词： pediatric liver transplantation Acute liver failure End-stage chronic liver disease Graft failure Patient survival Complications

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Hepatic artery reconstruction in pediatric liver transplantation:Experience from a single group

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 307-310页

作者： Ming-Xuan Feng Jia-Xu Zhang Ping Wan Bi-Jun Qiu Li-Hong Gu Jian-Jun Zhang Qiang Xia Department of liver Surgery Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200000China Department of Ultrasonography Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200000China

Background:The reconstruction of hepatic artery is a challenging part of the pediatric liver transplantation *** artery thrombosis(HAT)and stenosis are complications which may result in ischemic biliary injury,causing early graft lost and even ***:Two hundred and fifty-nine patients underwent liver transplantation in 2017 in a single liver transplantation *** them,225 patients were living donor liver transplantation(LDLT)and 34 deceased donor liver transplantation(DDLT).Results:In LDLT all reconstructions of hepatic artery were microsurgical,while in DDLT either microsurgical reconstruction or traditional continuous suture technique was done depending on different *** were five(1.9%)HATs:four(4/34,11.8%)in DDLT(all whole liver grafts)and one(1/225,0.4%)in LDLT(P=0.001).Four HATs were managed conservatively using anticoagulation,and 1 accepted salvage surgery with *** now,3 HAT patients remain in good condition,whereas two developed biliary *** of them needed to be re-transplanted,and the other patient died due to biliary ***:Microsurgical technique significantly improves the reconstruction of hepatic artery in pediatric liver *** risk for arterial complications is higher in *** therapy can achieve good outcome in selected HAT cases.

关键词： pediatric liver transplantation Vascular complication Hepatic artery thrombosis Microsurgery

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Effect of remote ischemic preconditioning among donors and recipients following pediatric liver transplantation:A randomized clinical trial

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World Journal of Gastroenterology 2021年第4期27卷 345-357页

作者： Bo Qi Xiao-Qiang Wang Shu-Ting Pan Pei-Ying Li Ling-Ke Chen Qiang Xia Li-Qun Yang Wei-Feng Yu Department of Anesthesiology Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200127China Clinical Center for Investigation Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200127China Department of transplantation and Hepatic Surgery Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200120China

BACKGROUND Studies suggested that remote ischemic preconditioning(RIPC)may effectively lessen the harmful effects of ischemia reperfusion injury during organ transplantation *** To investigate the protective effects of RIPC on living liver donors and recipients following pediatric liver *** From January 2016 to January 2019 at Renji Hospital Affiliated with Shanghai Jiao Tong University School of Medicine,208 donors were recruited and randomly assigned to four groups:S-RIPC group(no intervention;n=55),D-RIPC group(donors received RIPC;n=51),R-RIPC group(recipients received RIPC,n=51)and DR-RIPC group(both donors and recipients received RIPC;n=51).We primarily evaluated postoperative liver function among donors and recipients and incidences of early allograft dysfunction,primary nonfunction and postoperative complications among *** RIPC did not significantly improve alanine transaminase and aspartate aminotransferase levels among donors and recipients or decrease the incidences of early allograft dysfunction,primary nonfunction,and postoperative complications among *** protective effects were observed,including a lower creatinine level in the D-RIPC group than in the S-RIPC group on postoperative day 0(Pliver transplantation,and no significant improvement of the prognosis was observed in recipients.

关键词： pediatric liver transplantation Remote ischemic preconditioning Postoperative complications Ischemia reperfusion injury Primary nonfunction Hepatology

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Differences in parents of pediatric liver transplantation and chronic liver disease patients

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World Journal of Clinical Cases 2020年第11期8卷 2162-2172页

作者： Sami Akbulut Gulsen Gunes Hasan Saritas Bahar Aslan Yunus Karipkiz Khaled Demyati Sukru Gungor Sezai Yilmaz Department of Surgery and liver Transplant Institute Inonu University Faculty of MedicineMalatya 44280Turkey Department of Public Health Inonu University Faculty of MedicineMalatya 44280Turkey Department of Surgical Nursing Inonu University Faculty of Nursing'sMalatya 44280Turkey Department of Nursing Care Inonu University Faculty of Medicine Malatya 44280Turkey Department of Surgery An-Najah National University HospitalAn-Najah National UniversityNablus 11941Palestin Department of pediatric Gastroenterology Inonu University Faculty of MedicineMalatya 44280Turkey

BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their *** evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their *** To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients METHODS During this survey,data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017(LT group;n=91)and parents of pediatric patients with chronic liver disease(CLD group;n=94).Group comparisons were made based on the pediatric health-related quality of life(PedsQL)health care parent satisfaction scale,impact on family scale(IFS)and demographic *** PedsQL was administered to parents during a phone interview and the results were used to assess the health carerelated satisfaction of *** IFS was used to assess the impact of the child’s CLD status on the *** variables such as education level(elementary vs middle vs high vs university),monthly income(low vs middle vs high),and place of residence(village vs town vs city)were compared between CLD and LT parent ***,PedsQL and IFS results were also analyzed according to demographic *** A total of 185 parents aged 19 to 65 years were *** were statistically significant differences between the LT and CLD groups in terms of career(P<0.001),monthly income(P=0.016),and education level(P=0.041).According to the PedsQL results,family inclusion,communication,technical skills,emotional needs,and overall satisfaction were significantly different between the groups;the LT group had consistently higher scores(P<0.001).Additionally,scores for the IFS parameters of financial impact,familial-social impact,

关键词： liver transplantation pediatric liver transplantation Chronic liver disease Parent satisfaction Health-related quality of life health care parent satisfaction scale Impact on family scale

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Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation

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World Journal of Gastroenterology 2017年第46期23卷 8227-8234页

作者： Zhi-Yuan Zhang Long Jin Guang Chen Tian-Hao Su Zhi-Jun Zhu Li-Ying Sun Zhen-Chang Wang Guo-Wen Xiao Department of Interventional Radiology Beijing Friendship HospitalCapital Medical University Department of transplantation Surgery Beijing Friendship HospitalCapital Medical University Department of Radiology Beijing Friendship HospitalCapital Medical University

AIM To assess the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction(HVOO) following pediatric liver *** A total of 246 pediatric patients underwent liver transplantation at our hospital between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Seven procedures(two patients underwent two balloon dilatation procedures) were included in this analysis. The demographic data,types of donor and liver transplant, interventional examination and therapeutic outcomes of these five children were analyzed. The median interval time between pediatric liver transplantation and balloon dilatation procedures was 9.8 mo(range: 1-32).RESULTS Five children with HVOO were successfully treated by balloon angioplasty without stent placement, with seven procedures performed for six stenotic lesions. All children underwent successful percutaneous intervention. Among these five patients, four were treated by single balloon angioplasty, and these patients did not develop recurrent stenosis. In seven episodes of balloon angioplasty across the stenosis, the pressure gradient was 12.0 ± 8.8 mm Hg before balloon dilatation and 1.1 ± 1.5 mm Hg after the procedures, which revealed a statistically significant reduction(P pediatric liver transplantation. Venous angioplasty is also recommended in cases with recurrent HVOO.

关键词： Hepatic venous outflow obstruction pediatric liver transplantation Percutaneous transluminal balloon dilatation Pressure gradient Recurrent

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Advanced therapies for congenital biliary tract malformation:From bench to bedside

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iliver 2022年第3期1卷 159-168页

作者： Yixuan Shao Xinyu Yang Hao Chen Di Lu Yonggang Huang Xiao Xu People's Hospital Zhejiang University School of MedicineHangzhou310006China Department of Hernia and Abdominal Wall Surgery Affiliated Hangzhou First People's HospitalZhejiang University School of MedicineHangzhouChina Institute of Organ transplantation Zhejiang UniversityHangzhou310003China Westlake Laboratory of Life Sciences and Biomedicine Hangzhou310024China

Congenital biliary tract malformations are a series of rare but extremely serious diseases that mainly include biliary atresia and biliary hypoplasia(referred to as Alagille syndrome).The rapid progression of biliary atresia and Alagille syndrome results in jaundice,cholestatic liver disease,cirrhosis,and even liver *** most cases,supportive or clinically specific therapies cannot achieve satisfactory ***,liver transplantation(especially living donor liver transplantation)may be *** many studies have elucidated the role of genetic factors and the molecular mechanism of congenital biliary tract malformations,experimental therapies such as organoid transplantation,cell therapy,and immunotherapy have been proved to be *** advanced methods have shown outstanding advantages,particularly in patients with end-stage biliary tract malformations,surgery failure,and other problems that cannot be solved by conventional *** review article discusses the potential pathogenesis of and promising therapeutic strategies for biliary tract malformations.

关键词： Biliary tract malformation Biliary atresia Alagille syndrome pediatric liver transplantation Organoid Immunotherapy

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