| Objective1.To investigate the clinical efficacy and prognosis of liver grafts from donation after citizen’s death(DCD)in children to adult recipients in liver transplantation.2.To Compare the recovery of liver function and rates of postoperative complications of liver transplantation in adult recipients using child donors and adult donors respectively.MethodsA retrospective analysis was performed in 21 adult patients(> 18 years old)who underwent liver transplantation using liver grafts of child donors from August 2012 to October 2017 in The First Affiliated Hospital of Zhengzhou University.21 grafts were all from children(≤15 years old),the data was included in the child group(abbreviated as the group of liver grafts from children);the data of 35 adult recipients of liver transplantation using liver grafts of adult donors in the same period were collected,in order to exclude the effect of preoperative basal state on postoperative recovery and complications,We used the Propensity Score Matching method to analyze 1:1 matching data between adult donors group and child donors group using the MELD and Child-Pugh scores as control factors.The matched results were included as adults group(abbreviated as the group of liver grafts from adults).The study analyzes the clinical data of donors and recipients by statistical analysis to discuss the liver function recovery,complication rates,and survival rates of the recipients in the group of liver grafts from children,and compared with the group of liver grafts from adults.Results1.The age of the child donors was 10.1±3.2 years old(3-15 years old),height was 133.5±21.7cm(95-165cm)and the body weight was 31.7±13.1 kg(15-60 kg).The age of adult recipients and the body weight was 45.2±10.6 years old(21-61 years old)and 62.3±12.2kg(47-81 kg)respectively.Vascular and biliary complications occurred in 4 patients(19.0%)after the operation,including 2 cases(9.5%)of inferior vena cava thrombosis(IVCT),1 case(4.8%)of portal vein thrombosis(PVT),2 cases(9.5%)of biliary complications,Including 1 patient with IVCT and bile leakage simultaneously.Four cases(19.0%)of recipients developed initial poor graft function(IPGF).Complications occurred through symptomatic treatment,and all were cured.The postoperative hospital stay was 38.4 ± 17.2 days(17-84 days).The one-year survival rate was 94.1%,of which 1 died of renal failure.The remaining follow-up 20 patients(95.2%)survived in good condition.2.The age of the adult donors was 44.0±10.4 years old(22-62 years old),height was 172.2±5.4cm(158-183cm),and body weight was 70.3±8.6kg(45-85kg).Adult recipients aged 52.2±8.0 years old(25-65 years old),height was 171.5±7.0cm(158-186cm),and the body weight was 71.1±10.1kg(58-91kg).Biliary complications occurred in 2 patients(9.5%)after surgery and 1 vascular complications occurred.IPGF occurred in 3 patients(14.3%)after operation.One patient died of hepatic arterial hemorrhage after the operation,and the remaining 20 patients(95.2%)had good follow-up.3.There was no significant difference in the levels of ALT,AST,and TBil between the group of liver grafts from children and the group of liver grafts from adults at 7 days,1 month,3 months,and 6 months after operation(P>0.05);There was no significant difference in the incidence of vascular complications,incidence of biliary complications between the two groups(P>0.05).Conclusion1.The DCD donor livers from children can meet the needs of adults recipients with low weight for liver transplantation.Accurate preoperative assessment of donor livers,the selection of low body weight recipients,skilled surgical techniques and strict management of perioperative period are the keys to the success in adult recipients for liver transplantation using grafts from child donors.2.There was no difference in biliary vascular,complications complications and early graft function recovery between the two groups. |
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