Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2020; 26(12): 1352-1364
Published online Mar 28, 2020. doi: 10.3748/wjg.v26.i12.1352
Pediatric living donor liver transplantation decade progress in Shanghai: Characteristics and risks factors of mortality
Zhi-Ying Pan, Yi-Chen Fan, Xiao-Qiang Wang, Ling-Ke Chen, Qiao-Qun Zou, Tao Zhou, Bi-Jun Qiu, Ye-Feng Lu, Cong-Huan Shen, Wei-Feng Yu, Yi Luo, Dian-San Su
Zhi-Ying Pan, Yi-Chen Fan, Xiao-Qiang Wang, Ling-Ke Chen, Qiao-Qun Zou, Wei-Feng Yu, Dian-San Su, Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Tao Zhou, Bi-Jun Qiu, Ye-Feng Lu, Yi Luo, Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Cong-Huan Shen, Department of Liver Transplantation, Huashan Hospital, School of Medicine, Shanghai Fudan University, Shanghai 200040, China
Author contributions: Pan ZY, Fan YC and Wang XQ contributed equally to this work; Su DS, Shen CH, Wang XQ, Pan ZY, Fan YC, Qiu BJ , Luo Y and Yu WF proposed the study conception; Su DS, Shen CH , Chen LK, Luo Y, Zhou T and Yu WF designed the study; Pan ZY, Fan YC, Wang XQ, Lu YF, Chen LK, Qiu BJ, Zhou T and Zou QQ conducted the study; Fan YC, Wang XQ, Shen CH and Pan ZY analyzed the data; Su DS, Pan ZY, Fan YC, Wang XQ, Lu YF, Shen CH, Zou QQ, Qiu BJ, Luo Y, Zhou T and Yu WF interpreted the data; Su DS, Pan ZY, Chen LK, Fan YC, Wang XQ, Lu YF, Zhou T , Luo Y and Zou QQ wrote the paper; Su DS, Luo Y, Lu YF, Pan ZY, Wang XQ, Fan YC, Chen LK, Yu WF, Qiu BJ, Zhou T and Zou QQ revised the paper.
Supported by the National Natural Science Foundation of China, No. 81571030, No. 81771133 and No. 81970995; Shanghai Pudong New Area Municipal Commission of Health and Family Planning Funding, No. PW2016D-4; Shanghai Jiao Tong University integration funding of Medicine and Engineering, No. YG2017MS53; and Shanghai Shenkang Hospital Development Center Funding, No. SHDC12017X11.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Renji Hospital, School of Medicine, Shanghai Jiaotong University.
Informed consent statement: This is a retrospective study and exemption of signed informed consent application had been approved by Renji Hospital Ethics Committee.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dian-San Su, MD, PhD, Doctor, Professor, Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University, School of Medicine. 160 Pujian Road, Shanghai 200127, China. diansansu@yahoo.com
Received: November 24, 2019
Peer-review started: November 24, 2019
First decision: December 30, 2019
Revised: February 17, 2020
Accepted: February 28, 2020
Article in press: February 28, 2020
Published online: March 28, 2020
Abstract
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.

Keywords: Living donor, Liver transplantation, Anesthesia, Survival, Pediatric, Outcome

Core tip: The annual caseload of pediatric living donor liver transplantation has been growing rapidly and recipients have achieved excellent outcomes in Shanghai with 2-year patient survival rate of 89.34%. Moreover, pediatric end-stage liver disease score, anesthesia duration, operation duration, intraoperative blood loss, and intensive care unit length of stay were independent predictive factors of in-hospital patient survival. Pediatric end-stage liver disease score, operation duration, and intensive care unit length of stay were independent predictive factors of 1-year and 3-year patient survival.