ID 56374
JaLCDOI
FullText URL
Thumnail 72_6_567.pdf 2.09 MB
Author
Yagi, Takahito Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital
Takagi, Kosei Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital
Umeda, Yuzo Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital
Yoshida, Ryuichi Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital
Nobuoka, Daisuke Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital
Kuise, Takashi Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital
Fujiwara, Toshiyoshi Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Abstract
Living donor liver transplantation (LDLT) is the final therapeutic arm for pediatric end-stage liver diseases. Toward the goal of achieving further improvement in LDLT survival, we investigated factors affecting recipient survival. We evaluated the prognostic factors of 60 pediatric recipients (< 16 years old) who underwent LDLT between 1997 and 2015. In a univariate analysis, non-cholestatic (NCS) disease, graft/recipient body weight ratio, cold and warm ischemic times, and intraoperative blood loss were significant factors impacting survival. In a multivariate analysis, NCS disease was the only significant factor worsening survival (p=0.0021). One-and 5-year survival rates for the cholestatic disease (CS, n=43) and NCS (n=17) groups were 100% vs. 70.6% and 97.4% vs. 58.8% (p=0.004, log-rank). Intergroup comparisons revealed that CS was significantly associated with operation time, cold ischemia, hepatomegaly of the native liver, and portal plasty. These data suggest that a cirrhotic, swollen, artery-dominant liver did not increase graft size-related risks despite the surgical complexity of preceding operations. The NCS group’s poorer survival originated from recurrence of the primary disease and liver manifestation of systemic disease untreatable by transplantation. Improving the survival of pediatric recipients requires intensive efforts to prevent primary disease relapse and more rapid diagnoses to exclude contraindications from NCS disease.
Keywords
liver transplantation
living donor
pediatrics
prognostic factor
cholestatic disease
Amo Type
Original Article
Published Date
2018-12
Publication Title
Acta Medica Okayama
Volume
volume72
Issue
issue6
Publisher
Okayama University Medical School
Start Page
567
End Page
576
ISSN
0386-300X
NCID
AA00508441
Content Type
Journal Article
language
英語
Copyright Holders
CopyrightⒸ 2018 by Okayama University Medical School
File Version
publisher
Refereed
True
PubMed ID
NAID