Clinical Analysis Of Liver Transplantation With Liver Grafts From Pediatric Donors Used In Adult Recipients

Objective To investigate the clinical efficacy and prognosis of pediatric donor liver transplanted to adult recipients,and to compare the incidence of postoperative complications and short-term survival rate with adult donor liver transplanted to adult recipients.Methods Taking donors and recipients of 70 liver transplantations from organ donation after citizen's death as research object in the Organ Transplantation Center of the First Affiliated Hospital of Anhui Medical University from February 2015 to January 2020,the clinical data and prognosis were retrospectively analysed.In addition,the liver transplantation cases with adult recipients were divided into child-adult group 6 cases and adult-adult group 62 cases according to donors<12 years old and donors>18years old,the clinical data of donor,recipient,perioperative period,postoperative complications and prognosis were studied by means of single factor analysis between the two groups,and calculated the 1-and 3-year cumulative survival rates and compared the short-term survival rate between the two groups according to the Kaplan-Meier curve.Results The single factor analysis showed that:(1)donor factors:there were significant differences in gender,age,BMI,donor liver weight,donor liver volume,and ICU treatment time between the two groups(P<0.05),there were no significant differences in warm ischemia time,cold ischemia time and the level of Na~+,ALT,AST,TB before procurement between the two groups(P>0.05);(2)recipient factors:there were significant differences in gender,BMI,GV/SLV,and GRWR between the two groups(P<0.05),there were no significant differences in Age,number of Child C,and number of MELD score>25 between the two groups(P>0.05);(3)perioperative factors:there were no significant differences in recipient ICU treatment time,recipient hospitalization days,operation time,anhepatic phase,intraoperative blood loss,intraoperative red blood cell and plasma transfusion,the incidence of major complications and mortality between the two groups(P>0.05).During the follow-up period,among 6 cases in the child-adult group,major postoperative complications occurred in 4 recipients,and 1recipient died from sepsis/multiple organ failure.Among 62 cases in the adult-adult group,major postoperative complications occurred in 22 recipients,and 11 recipients died,the causes of death were 5 cases of sepsis/multiple organ failure,1 case of primary nonfunction,2 cases of biliary complications,1 case of massive gastrointestinal bleeding,1 case of denovo malignancy in transplanted liver,1 case of cardiac and respiratory failure caused by Guillain-Barre syndrome.The 1-and 3-year cumulative survival rates in all recipients were 82.5%and 78.4%,respectively,and there was no significant difference in the short-term survival rate between the two groups according to the Kaplan-Meier curve and statistical results(P>0.05).Conclusion 1.The 1-and 3-year cumulative survival rates of the liver transplantation recipients in our center are 82.5%and 78.4%,respectively,and sepsis/multiple organ failure are the main reasons of early postoperative death.2.Detailed evaluation of donors and recipients and individual management during perioperative period can ensure successful application of pediatric livers in adult recipients and obtain good clinical efficacy,and there is no significant difference in incidence of postoperative complications and short-term survival rate between child-adult group and adult-adult group.