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Results of a newborn liver transplant program in the era of piggyback technique and extended donor criteria in Italy

机译：背负式技术时代的新生儿肝脏移植计划的结果以及延长的捐助者标准在意大利

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The aim of this study was to critically analyze the early and long-term results of a newborn liver transplantation (LTx) centre using piggyback technique (PT) without venovenous bypass and portocaval shunt in the era of extended criteria donors (ECDs). Between 2002 and 2010, a total of 229 LTx were performed in 225 patients, with the shortest as possible cold ischemia time (CIT) policy. The charts of the donors and recipients and the intraoperative data were retrospectively reviewed in order to define the feasibility of PT and surgical outcome, and long-term graft and patient survival. PT feasibility rate was 100%, with a median duration of surgery of 390 min (range 210–630) and median unit of packed RBC transfused intraoperatively of 1 U (range 1–10). Median CIT was 400 min (range 130–870), and median AST peak was 403 mmol/L (range 48–16,900). ECDs graft rate was 85%. Over all primary dysfunction and non-function (PNF) rates were 7.4 and 2.2%, respectively and increased with graft steatosis >30% (P < 0.004). Mortality, morbidity, re-operation and re-LTx rates were 4.4, 25, 6.1 and 1.3%, respectively, and median hospital stay was 18 days (range 8–150). On the long term, graft and patient 5-year overall survival were 72 and 74%, respectively, and re-LTx rate was 0.4%. Survival was significantly affected by recipient HCV-Ab seropositive status (67 vs. 85%, P = 0.023). Liver transplantation can be performed with low morbidity and mortality rates, despite ECDs. PT is a safe and effective procedure that, combined with short CIT, entailed prompt early functional recovery of the grafts and positive long-term results.
机译：这项研究的目的是在扩展标准捐献者（ECD）时代使用背piggy式技术（PT）进行无静脉旁路和门静脉分流的严格肝移植中心（LTx）新生儿的早期和长期结果分析。在2002年至2010年之间，共对225名患者进行了229次LTx治疗，并采用了最短的冷缺血时间（CIT）策略。回顾性分析供体和受体的图表以及术中数据，以确定PT和手术结局的可行性，以及长期移植和患者生存率。 PT可行性率为100％，中位手术时间为390分钟（范围210–630），术中输注包装红细胞的中位单位为1 U（范围1–10）。 CIT中位数为400分钟（范围130–870），AST峰值中位数为403 mmol / L（范围48–16,900）。 ECDs移植率为85％。在所有原发性功能障碍和非功能性（PNF）发生率中，分别为7.4％和2.2％，并且随着移植脂肪变性> 30％而增加（P <0.004）。死亡率，发病率，再次手术和再次LTx发生率分别为4.4％，25％，6.1％和1.3％，中位住院时间为18天（范围8–150）。从长期来看，移植物和患者5年总生存率分别为72％和74％，re-LTx率为0.4％。受体HCV-Ab血清反应阳性显着影响生存率（67 vs. 85％，P = 0.023）。尽管有ECD，但肝移植的发病率和死亡率均较低。 PT是一种安全有效的方法，结合较短的CIT，可尽早使移植物早期恢复功能并获得长期的积极效果。

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