The Research Of Early Complications For Different Type Of Graft After Pediatric Liver Transplantation

Objective:To study the incidence of early postoperative complications and early postoperative survival rate for the types of graft, the risk factors of early postoperative surgical complications and the impanct of early postoperative surgical complications for early postoperative survival rate after pediatric liver transplantation, provide reference for clinical treatment.Methods:This study data collected included1) the donor information (age, weight);2) the receptor information (age, gender, weight, preoperative INR, preoperative TBIL levels, The primary disease, accept Kasai surgery or not before LT),3) the operation information (date, the amount of time, blood loss volume, dosage of red blood cells, the way of Biliary reconstruction),4) the graft information (warm ischemia time, cold ischemia time, weight, Graft to Recipient Weight Ratio),5) postoperative situation (the incidence of early postoperative complications, the incidence of main early postoperative complications, follow-up time, recipient survival rate, the time of death, the cause of death). The children with end-stage liver disease were been treated by the same liver transplant surgical team during the2006-2013included in the study. According to different types of graft the patients undergoing liver transplant were divided into three groups, namely whole liver transplantation(WLT), split liver transplantation(SLT) and living donor liver transplantation(LDLT). Compare the data of operation, the incidence of early postoperative complications and recipient survival rate. Learning the characteristics of liver transplantation for different types of graft, the incidence of early postoperative complications and survival in recipient with postoperative. Unconditioned logistic regression is used to analyze the risk factors of early postoperative complications. Early postoperative complications as covariate, Kaplan-Meier single-factor analysis and COX Multivariate Model is applied to the analysis of risk factors for postoperative recipient died.Results:137patients with end-stage liver disease had liver transplantation included in the study, the whole liver transplantation19cases (13.9%), split liver transplantation20cases (14.6%), living donor liver transplantation98cases (71.5%).79males (57.7%),58females(42.3%). Median age10month (5-161month), median weight8.0Kg (4.5-37Kg), the median height70cm (50-148cm), surviving recipients median follow-up time was9.9months (3.1-82.5months).Donor information, recipient information, operation information, graft information and postoperative situation comparison according to graft type. Donor age of WLT is minimum (P<0.001) and the weight ofWLT is lightest (P<0.001),the age of receptor is youngest (P=0.001), the weight of receptor is heaviest (P=0.023); the warm ischemia time and cold ischemia time of LDLT graft is shortest (P<0.001, P<0.001, respectiely), WLT’s graft is heaviest(P<0.001); PLT has the most intraoperative blood loss and volume of red blood cell transfused in the operation(P<0.001, P=0.001, respectiely), the time of WLT’s operation is shortest (P=0.002) and the proportion of duct-duct for biliary reconstruction is highest (P=0.020); Receptors Preoperative total bilirubin, receptors preoperative INR and GRWR no statistical difference.Comparing the incidence of early complications for different types of graft afterliver transplantation, early postoperative complication rates of PLT is significantly higher than the WLT and LDLT (P=0.001), and there is no statistical difference between the WLT and LDLT (P=0.779). The Comparison of incidence for main early postoperative complications show that, the incidence of early postoperative infection in PLT is significantly higher than WLT and LDLT (P<0.001), and there is no statistical difference between the WLT and LDLT (P=0.503). Regression analysis showed that if the amount of intraoperative red blood cell transfusion is more than750mL, the risk of early postoperative complications increase; if the amount of intraoperative red blood cell transfusion is more than435mL, the risk of early bile leakage increase, if the amount of intraoperative red blood cell transfusion is more than435mL, the risk of early bile leakage increase; if the amount of intraoperative red blood cell transfusion is more than750mL or cold ischemia time of graft is more than425min, the risk of early infection increase.Early postoperative survival rate and postoperative patients with long-term survival rate after liver transplantation had no statistical difference for the patients with Different type of graft (the Log rank test, P=0.201). The mortality of recipients with early postoperative complications is higher (the Log rank test, P=0.006), Kaplan-Meier single-factor analysis and COX Multivariate Model showed that the risk factors of recipients for postoperative mortality include early postoperative bile leakage (P=0.040), bleeding (P<0.001) and infection (P=0.016).Conclusions:Split and living donor are important source of graft in pediatric liver transplantation, incidence of verall early complications and early postoperative infection rates after PLT is higher WLT and LDLT. Although the. recipients postoperative survival rate is lowest in PLT, but this difference was no statistically significant, the incidence of early postoperative surgical complications, early postoperative survival is no statistically significant. Early postoperative complications, especially early postoperative bile leakage, bleeding and infection are risk factors of recipients death fater pediatric liver transplantation.