Results of pediatric living donor compared to deceased donor liver transplantation in the PELD/MELD era: Experience from two centers on two different continents

The LDLT option in the pediatric population allows recipients to be transplanted early. A total of 202 consecutive pediatric liver transplants from two different institutions—108 (LDLT) and 94 (DDLT)—were retrospectively compared. Overall, one‐ and three‐yr patient and graft survival were similar between DDLT and LDLT. ACR was greater in recipients of DDLT at one and three yr (50.8% and 61.0%) compared to LDLT (30.8% and 32.2%) (p = 0.002). When the data were stratified according to PELD/MELD score, LDLT with a low score had better one‐ and three‐yr graft survival (96.2% and 96.2%) compared to DDLT (88.2% and 85.2%) (p = 0.02), with comparable patient survival (p = 0.75). Patient and graft survival were similar between DDLT and LDLT in the high PELD/MELD group. Lower incidence of ACR in both low and high PELD/MELD groups was (29.6% and 34.3%) for LDLT compared to DDLT (50.3% and 53.3%, p = 0.002 and p = 0.028, respectively). Regardless of PELD/MELD score, status, age group, and recipient weight, LDLT provides excellent patient and graft survival with a lower incidence of rejection compared to DDLT.     

Evaluation and management of end-stage liver disease in children

End-stage liver disease in children presents a challenging array of medical and psychosocial problems for the health care delivery team. Many of these problems are similar to those encountered by caregivers of adults with end-stage liver disease, such as the development of complications of cirrhosis, including ascites, spontaneous bacterial peritonitis, and esophageal variceal hemorrhage. However, the natural history of disease progression in children and their responses to medical therapy can differ significantly from that of their adult counterparts. Children with end-stage liver disease are especially vulnerable to nutritional compromise; if not effectively managed, this can seriously impact long-term outcomes and survival both before and after liver transplantation. Moreover, close attention must be given to vaccination status and the clinical setting at which health care is delivered to optimize outcomes and the delivery of high-quality pediatric health care. In this review, we address important components of the evaluation and management of children with chronic end-stage liver disease.     

Reoperative complications following pediatric liver transplantation

Background

The aim of this study is to describe the incidence and impact of reoperation following pediatric liver transplantation, as well as the indications and risk factors for these complications.

Feasibility and safety of using low-body-weight donors in pediatric liver transplantation

BackgroundDonors with low-body-weight were previously reported to be related to inferior recipient outcomes in pediatric liver transplantation. However, the scarce availability of age and size-matched organs has encouraged us to re-evaluate the feasibility and safety of using low-body-weight donors.MethodsWe retrospectively analyzed 91 deceased donor pediatric liver transplantation between January 2014 and December 2016, donor weight less than 5 kg was defined as low-body-weight donors. The recipients were divided into two groups according to donor weight.(≤ 5 kg and 5 kg < to ≤ 20 kg). Donor and recipient characteristics, perioperative data, postoperative complications as well as graft and recipient survival rate were comparedResultsThe recipients and grafts recovery after transplantation were comparable between two groups. The recipients receiving low-body-weight donors showed higher risk of hepatic artery thrombosis and small-for-size syndrome, however, these complications can effectively be treated by our strategies. The 2-year patient survival rates were 92.9% and 95.2%, 2-year graft survival rates were 92.9% and 93.7% in Groups 1 and 2, without significant difference.ConclusionsOur finding suggested that the utility of livers from low-body-weight donors is a potential strategy to increase donor availability in well-selected pediatric recipients.Level of EvidenceIII     

3D打印导板在经椎间孔内镜技术定位穿刺中的初步应用

目的 探讨3D打印导板在椎间孔镜手术穿刺中的定位效果。方法 选择2016年10月至2017月2月在滨州医学院附属医院神经外科接受椎间孔镜手术的4例患者,其中男2例,女2例。通过Mimics软件获得腰椎的三维立体图形,设计最佳的穿刺路径并制作个性化穿刺导板。术中将导板严密贴合于穿刺部位,沿3D打印导板定位穿刺,通过C型臂透视机观察进针的准确性。结果 4例患者顺利制作了3D打印穿刺定位导板,并在导板引导下完成定位穿刺操作。4例患者中穿刺精准度满意者2例,合格者1例,差者1例。术中C型臂X光机透视定位均显示穿刺成功,未出现重要组织及血管的损伤。结论 3D打印导板可以有效提高椎间孔镜穿刺的准确性,降低透视次数以及有效提高手术率。     

经皮腰椎内窥镜下手术麻醉方案选择的前瞻性随机对照研究

目的 :探讨不同局部浸润麻醉方法对经皮腰椎内窥镜下手术中疼痛的控制效果。方法 :2015年2月~2015年6月在我院因腰椎间盘突出症接受经皮内窥镜下腰椎间盘切除术(PELD)治疗的患者纳入本研究,随机分为两组:A组麻醉方法为浓度1%的利多卡因稀释溶液局部浸润麻醉;B组为在A组的基础上加入盐酸罗哌卡因注射液100mg局部浸润麻醉并在手术开始前静脉注射枸橼酸芬太尼注射液0.05mg及盐酸昂丹司琼注射液8mg。采用椎间孔成形期VAS评分、纤维环操作期VAS评分、术后即刻及术后24h再手术意愿评估术中疼痛控制效果。结果:共82例患者纳入研究,A组42例,B组40例。椎间孔成形期B组在平均疼痛VAS评分(1.1±0.9)及峰值疼痛VAS评分(1.3±0.9)上都显著低于A组(3.2±2.4及5.1±2.3)。纤维环相关操作期两组间平均疼痛VAS评分和峰值VAS评分无显著差异。B组术后即刻再手术意愿显著高于A组(95.0%∶71.4%),术后24h两组再手术意愿无显著差异(97.5%∶97.6%)。两组患者术后均未出现麻醉及手术相关并发症。结论 :采用利多卡因及罗哌卡因混合局麻联合静脉芬太尼镇痛的麻醉方案在不增加手术风险的前提下可显著改善腰椎内镜手术术中疼痛控制。     

醋酸去氨加压素在椎间孔镜手术中的应用

目的观察在椎间孔镜手术前应用醋酸去氨加压素对术中出血量、血液相关指标的影响,评价其在临床上的应用价值。方法选取2017年11月-2018年7月在该院行椎间孔镜手术的腰椎间盘突出症患者135例为研究对象,随机数字法分为对照组和试验组。对照组67例,试验组68例,对照组患者常规术前准备,试验组患者在常规术前准备基础上,术前30 min静脉应用醋酸去氨加压素3 ml。比较两组患者镜下效果、术中出血情况、手术时间及血液相关指标[血红蛋白浓度(HGB)、红细胞压积(HCT)、血小板数目(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]。结果试验组镜下效果满意37例,一般31例,差0例,对照组镜下效果满意23例,一般39例,差5例。试验组术中出血量(9.93±1.10)ml,手术时间(62.78±7.63)min,对照组术中出血量(10.68±1.34)ml,手术时间(67.43±8.28)min,术前两组患者各项血液指标比较,差异无统计学意义(P>0.05);术后两组患者的HCT和PT差异无统计学意义(P>0.05),试验组患者HGB和PLT与对照组比较,差异有统计学意义(P<0.05),试验组患者APTT与对照组比较,差异有统计学意义(P<0.01);对照组患者各项血液相关指标术前与术后比较,差异无统计学意义(P>0.05),试验组患者HGB、HCT、PLT和PT术前与术后比较,差异无统计学意义(P>0.05),试验组患者APTT术前与术后比较,差异有统计学意义(P<0.01)。结论醋酸去氨加压素应用于腰椎椎间孔镜手术中,可启动内源性凝血途径,缩短部分活化凝血活酶时间,促进凝血,达到止血的目的,对控制患者术中出血量有积极的意义,从而提高镜下效果,缩短手术时间,值得在临床上大力推广。     

椎间孔镜治疗椎间隙塌陷的腰椎间盘突出症预防出口神经根损伤的措施

目的 分析侧路椎间孔镜对椎间隙塌陷的腰椎间盘突出症患者的临床效果,探讨避免出口神经根损伤的手术技巧.方法 回顾性分析2017年1月至2019年12月在本院行侧路椎间孔镜手术治疗的椎间隙塌陷的腰椎间盘突出症患者47例,观察并比较术中、术后出口根并发症,术前、术后24h、术后1周、末次随访时视觉模拟评分(VAS)、日本骨科...     

Outcome after pediatric liver transplantation impact of living donor transplantation on cost

OBJECTIVE: To compare the direct health care cost of living donor liver transplantation (LDLT) with that of cadaver donor liver transplantation (CDLT) in children and identify predictors of cost. STUDY DESIGN: All 16 children who underwent LDLT from January 1997 through January 2002 at Cincinnati Children's Hospital Medical Center comprised the study population. They were matched for age, diagnosis, and nutritional status with 31 children who received CDLT during the same era. A historic cohort analysis was performed. RESULTS: There was no difference in the 1-year mortality rates between both groups. Costs associated with graft retrieval contributed 15.3% and 31% of the initial transplant cost for LDLT and CDLT, respectively. Mean cost of care in the first year was 60.3% higher for LDLT than CDLT (P=.01). Multivariate analysis identified biliary complications and insurance status as predictors of cost for initial transplantation (R(2)=0.57), whereas biliary complications and pediatric end stage liver disease scores were identified as predictors of cost of care in the first year after transplantation (R(2)=0.77). CONCLUSIONS: The comprehensive cost of LDLT in the first year after transplantation is higher than cadaveric transplantation. This must be balanced against the time spent and care needs of patients on the waiting list.