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Objective:To explore the clinicalfactors related to allograft fibrosis after pediatric liver transplantation.Methods:The clinical data were respectively analyzed for 94 pediatric recipients from January 2013 to December 2016 at Tianjin First Central Hospital.The Patients were assigned into fibrotic and non-fibrotic groups based upon the results of protocol liver biopsies. Univariate and multivariate Logistic regression analyses were performed for examining the risk factors of fibrosis after pediatric livertransplantation. Then Logistic regression model was established to obtain the predicted value of combined predictive factors.Thereceiver operating characteristic curve (ROC) was conducted to evaluate the predictive value of combined predictive factors.Results:A total number of 54(57.5%) patients occurred fibrosis among the 94 patients. There weresignificant differences in cold ischemia time (Z=2.094), warm ischemia time (Z=2.421), biliary stricture( χ2=4.560), drug-induced liver injury ( χ2=7.389), hepatic artery thrombosis and rejection ( χ2=6.955)between two groups ( P<0.05). Logistic regression analysis showed that cold ischemia time (OR=1.003, 95%CI: 1.000~1.007, P=0.044), biliary stricture(OR=6.451, 95%CI: 1.205~33.295), rejection(OR=2.735, 95%CI: 1.057~7.077)and drug-induced liver injury (OR=4.977, 95%CI: 1.207~20.522, P=0.026) were independent risk factors for fibrosis 5 years after liver transplantation. The area under the ROC curve was 0.786(95%CI: 0.691~0.881), for predicting patient outcome.If using 0.311as a cutoff Value, the sensitivity was 90.70%, and the specificity was 60.00%. However, through the ROC curve comparison, there was statistical significance between combined predictive factors and the other independent risk factors ( P>0.05). Conclusions:The incidence of fibrosis 5 years after pediatricliver transplantation is 57.5%. Prolonged cold ischemia time, biliarystricture, rejectionand drug-induced liver injury after liver transplantation are independent risk factors for fibrosis 5 years after pediatric liver transplantation.And the combined predictive factors have a high predictive value forallograftfibrosis.
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Objective:To explore the preventive efficacy of 2-week ganciclovir intravenous injection for CMV infection after pediatric liver transplantation(LT).Methods:Clinical data were retrospectively analyzed for 404 pediatric LT recipients from January 1, 2015 to December 31, 2017. According to whether or not ganciclovir was intravenously administered for preventing CMV infection, they were divided into two groups of prevention(235 cases)and non-prevention(169 cases). The preoperative, intraoperative and postoperative follow-up data of two groups were recorded. Survival rate, incidence of CMV infection and time of initial CMV infection were compared between two groups.Results:The median follow-up time of 404 pediatric liver transplantation recipients was 856 days and the incidence of CMV infection 39.1%. No inter-group statistical difference existed in such basic clinical data as gender, age, primary disease, preoperative PELD score, CHILD grade, operative duration, intraoperative blood loss, immunosuppressive regimen or rejection rate. The median follow-up time of two groups was 1014 and 731 days; The incidence of CMV infection 37.4%(88/235)and 41.4%(70/169); The average postoperative time of initial CMV infection 75.5 and 110.2 days; The rate of CMV re-infection after initial CMV infection 26.1%(23/88)and 18.6%(13/70)respectively. No significant inter-group differences existed( P>0.05). Conclusions:Early postoperative 2-week intravenous ganciclovir injection fails to reduce the incidence of CMV infection after pediatric LT, nor delay the occurrence time of CMV infection. It is not recommended as a preventive program for CMV infection after pediatric LT.
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Objective To evaluate the feasibility and safety of using pediatric donation after brain death donors during split liver transplantation .Methods The clinical data were retrospectively reviewed for 8 pediatric recipients undergoing split liver transplantation with a donor age of 2 .7-7 years .The clinical characteristics of donors/recipients ,perioperative course ,postoperative recovery and complications along with graft and recipient survival rate were analyzed .Results The split procedure was performed ex situ (n=3) and in situ (n=1) ,all liver grafts were split into left lateral lobes and extended right lobes . The recipients were children aged 4 .7-105 .5 months . The mean follow-up period was (8 .1 ± 0 .6) months and the graft/recipient survival rates approached 100％ . Graft functions remained normal in all recipients at the end of follow-ups .Two recipients undergoing liver grafting with long cold ischemia time exhibited slower recovery of graft function .Pathological examination of graft biopsy indicated ischemic and hypoxic changes .Portal vein stenosis occurred in one recipient .Percutaneous transhepatic portal vein balloon dilatation was performed and the recipient recovered well .Cytomegalovirus infection occurred in 5/8 recipients and serum virological marker returned to normal after ganciclovir therapy . The youngest donor age was 2 .7 years and both recipients of donor liver recovered well .Conclusions Split liver transplantation with a donor age of 2 .7-7 .0 years may achieve ideal clinical outcomes in well-matched donors and recipients .
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Objective To analyze the clinical efficacy and prognosis of living donor liver transplantation (LDLT) in children with biliary atresia (BA).Methods The clinical data of 306 cases of BA patients who received LDLT from June 2013 to December 2017 in the Department of Pediatric Liver Transplantation of Tianjin First Center Hospital were retrospectively analyzed.The incidence of post-LDLT complications was summarized and different factors influencing long-term survival of the recipients were analyzed.Results The median age of recipients at transplantation was 7 (6,9) months,and 88.9％ of the recipients received left lateral lobes.The surgical-related complications mainly included lymphatic leakage (30.7％),bile duct stricture (7.8％) and portal vein stenosis (6.9％).The non-surgical-related complications were mainly EBV infection (57.8％) and CMV infection (36.6％).The incidence of pulmonary infection and acute rejection was 18.6％ and 13.7％,respectively.The 1-,3-,and 5-year survival rates of recipients and grafts were 97.2％,97.2％,97.2％ and 97.2％,96.4％,and 94.6％,respectively.A total number of 8 patients died after LDLT,mainly due to the complications of cardio-pulmonary system.Two patients underwent retransplantation due to graft dysfunction caused by antibody-mediated rejection.Recipient age,PELD scores,GRWR,previous surgical history and matching of ABO blood group between donors and recipients did not affect the long-term survival rates of recipients (P＞0.05).Conclusions Children with biliary atresia who received LDLT can obtain satisfactory clinical results.