| Objective:To investigate the effect of age on the outcome of living donor liver transplantation(LDLT)in children.Methods:The clinical data of children undergoing living donor liver transplantation from July 2017 to November 2018 in a single center of our hospital were retrospectively analyzed.They were divided into two groups according to the age of operation<12M(group A)and<12M(group B).The general preoperative data,intraoperative conditions,changes of liver function,complications(intestinal complications,acute rejection,vascular complications and biliary complications)and life of the recipients in the two groups were analyzed.Comparison and statistical analysis of survival.Results:(1)There are 27 cases in this group,18 cases in group A and 9 cases in group B.The age of recipient operation ranged(5.6,-106.0,8.0).(2)Both height(group A:63.61±1.88,group B:96.22±27.56,P=0.00)and body weight(group A:6.6±0.72,group B:96.22±27.56,P=0.00)of group B are higher than those of group A.(3)The time of cold ischemia in group A is longer than that in group B(group A:139.06±28.04,group B:110.56±24.12,P=0.015).(4)The difference of end-stage liver disease(PEL D)score of children(group A:6.33±10.12,group B:6.78±13.51,P=0.924)、graft mass to recipient mass ratio(GRWR)(group A:3.73±0.92,group B:2.82±1.16,P=0.061)、body mass index(BMI)(group A:16.29±1.44,group B:15.34±1.33,P=0.11)、intraoperative warm ischemia time(group A:13.00±7.15,group B:9.11±5.42,P=0.164)、intraoperative anhepatic phase time(group A:61.33±22.66,group B:57.78±17.95,P=0.686)、intraoperative inferior vena cava occlusion time(group A:35.89±20.11,group B:59.33±15.77,P=0.699)、the time of portal vein occlusion(group A:72.33±25.92,group B:32.89±15.50,P=0.181)and the time of operation(group A:712.44±266.46,group B:849.11±303.87,P=0.241)are not statistically significant between the two groups.(5)The difference of the diameter of donor hepatic artery(group A:2.75±1.36,group B:2.61±0.59,P=0.774),the diameter of recipient portal vein trunk(group A:5.41±1.46,group B:7.24±6.17,P=0.236),the diameter of recipient hepatic artery inherent artery(group A:3.61±1.27,group B:4.01±0.78,P=0.400),the diameter of recipient left hepatic artery(group A:2.73±0.76,group B:2.73±0.52,P=0.998)are not statistically significant between the two groups.(6)The inner diameter of right hepatic artery of group A is smaller than that of group B(group A:2.55±0.46,group B:3.02±0.69,P=0.043),and the difference are statistically significant.(7)The difference ofthe normal time of total bilirubin(T B i L)(group A:10.00±7.05,group B:11.25±7.03,P=0.686),the normal time of aspartate aminotransferase(AST)(group A:11.13±13.48,group B:8.00±3.29,P=0.529)and the normal time of alanine aminotransferase(ALT)(group A:13.63±4.05,group B:12.63±3.34,P=0.553)are not statistically significant between group Aand group B.(8)There difference of total bilirubin,direct bilirubin,aspartate aminotransferase,alanine aminotransferase and glutamyltransferase between the two groups at 1、2 and 4 weeks after operation(all P>0.05)are no statistically significant.(9)There were no differences in intestinal complications(group A:16.7%,group B:11.1%,χ~2=0.147,P=0.702),acute rejection(group A:16.7%,group B:0%,χ~2=1.689,P=0.194)and vascular complications(group A:11.1%,group B:11.1%,χ~2=1.689,P=0.750)between the two groups.(10)There were no biliary complications such as biliary fistula and biliary stricture in the two groups.Except for 3 cases of vascular complications,liver function of the rest of the children can be reduced to normal after surgery.(11)There was no difference in the incidence of postoperative complications between the two groups(group A:44.4%,group B:22.2%,χ~2=0.885,P=0.348).(12)There was no difference in the survival rate of recipients between the two groups(11.1%in group A,11.1%in group B,Log-rankχ~2=0.00,P=0.987).Conclusions:Age factors have a certain impact on the surgical procedures of living donor liver transplantation in children,mainly because children younger than 1 years old have small vascular diameter and long cold ischemia during the operation,but have no impact on the surgical effect. |
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