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Pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of
Zhi-Ying Pan1, Yi-Chen Fan1, Xiao-Qiang Wang1
1Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
Insights
Pediatric living donor liver transplantation (LDLT) in China shows improving survival rates, with PELD score, operation duration, and ICU stay being key survival factors. This study highlights advancements in anesthetic management and outcomes for pediatric end-stage liver disease patients.
Area of Science:
- Hepatology
- Pediatric Surgery
- Anesthesiology
Background:
- Pediatric living donor liver transplantation (LDLT) is the standard treatment for end-stage liver disease in children.
- Significant global advancements in surgical and anesthetic techniques have improved LDLT outcomes.
- Limited data exist on anesthetic management and survival rates for pediatric LDLT in China.
Purpose of the Study:
- To review the current status of pediatric LDLT in Shanghai.
- To investigate factors influencing anesthetic management and survival rates in pediatric LDLT patients.
Main Methods:
- A retrospective observational study analyzed 544 pediatric LDLT cases.
- Data were collected from Renji Hospital and Huashan Hospital between October 21, 2006, and August 10, 2016.
Main Results:
- Overall survival rates at 30 days, 90 days, 1 year, and 2 years were 95.22%, 93.38%, 91.36%, and 89.34%, respectively.
- A significant improvement in 2-year survival was observed after January 1, 2011 (90.74% vs. 74.47%).
- Median mechanical ventilation duration was 18 hours, ICU length of stay was 6 days, and postoperative length of stay was 24 days.
Conclusions:
- Pediatric end-stage liver disease (PELD) score, anesthesia duration, operation duration, intraoperative blood loss, and ICU length of stay independently predict in-hospital survival.
- PELD score, operation duration, and ICU length of stay are independent predictors of 1-year and 3-year survival.
Background:
Pediatric living donor liver transplantation (LDLT) has become the gold standard for patients with end-stage liver disease. With improvements in organ preservation, immunosuppression, surgical and anesthesia techniques, the survival rates and long-term outcomes of patients after LDLT have significantly improved worldwide. However, data on anesthetic management and postoperative survival rate of pediatric LDLT in China are rare.
Aim:
To review the status of pediatric LDLT in Shanghai and investigate the factors related to anesthetic management and survival rate in pediatric LDLT.
Methods:
We conducted a retrospective observational study to investigate the status of pediatric LDLT in Shanghai by reviewing 544 records of patients who underwent pediatric LDLT since the first operation on October 21, 2006 until August 10, 2016 at Renji Hospital and Huashan Hospital.
Results:
The 30-d, 90-d, 1-year, and 2-year survival rates were 95.22%, 93.38%, 91.36%, and 89.34%, respectively. The 2-year patient survival rate after January 1, 2011 significantly improved compared with the previous period (74.47% vs 90.74%; hazard ratio: 2.92; 95% confidence interval (CI): 2.16-14.14; P = 0.0004). Median duration of mechanical ventilation in the intensive care unit (ICU) was 18 h [interquartile range (IQR), 15.25-20.25], median ICU length of stay was 6 d (IQR: 4.80-9.00), and median postoperative length of stay was 24 d (IQR: 18.00-34.00). Forty-seven (8.60%) of 544 patients did not receive red blood cell transfusion during the operation.
Conclusion:
Pediatric end-stage liver disease (PELD) score, anesthesia duration, operation duration, intraoperative blood loss, and ICU length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score, operation duration, and ICU length of stay were independent predictive factors of 1-year and 3-year patient survival.
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