vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/25/1995-1191-2021-4-26-31vtio-1291Research ArticleКлиническая трансплантологияClinical TransplantologyЧастота возникновения и факторы риска развития хронического отторжения при остром отторжении трансплантированной печени у детейThe incidence and risk factors of chronic rejection in acutely rejected pediatric liver transplantationДехганиС. М.DehghaniS. M.

Шираз

Iraj Shahramian, Full Professor of Pediatric Gastroenterology and Hepatology

Shiraz

Tel/fax: +985432239031

ir_buper@yahoo.comШахрамянИ.ShahramianI.

Забол

Zabol

АятоллахиМ.AyatollahiM.

Шираз

Zabol

ПарооФ.ParooieF.

Забол

Zabol

СаларзаиМ.SalarzaeiM.

Забол

Zabol

БахманьярМ.BahmanyarM.

Фаса

Fasa

СаргазиА.SargaziA.

Забол

Zabol

ДеларамнасабМ.DelaramnasabM.

Забол

Zabol

Центр трансплантации органов Шираз, Больница Немази, Ширазский университет медицинских наукИранShiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical SciencesIslamic Republic of IranИсследовательский центр детской гастроэнтерологии и гепатологии, Заболский университет медицинских наукИранPediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical ScienceIslamic Republic of IranУниверситет медицинских наук ФасаИранFasa University of Medical ScienceIslamic Republic of Iran2021221020212342631Copyright © Дехгани С.М., Шахрамян И., Аятоллахи М., Пароо Ф., Саларзаи М., Бахманьяр М., Саргази А., Деларамнасаб М., 20222022Дехгани С.М., Шахрамян И., Аятоллахи М., Пароо Ф., Саларзаи М., Бахманьяр М., Саргази А., Деларамнасаб М.Dehghani S.M., Shahramian I., Ayatollahi M., Parooie F., Salarzaei M., Bahmanyar M., Sargazi A., Delaramnasab M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1291Актуальность

Актуальность. Хроническое отторжение (ХО) трансплантата становится все более серьезной проблемой при трансплантации печени (ТП) у детей. Факторы риска ХО в этой популяции остаются неопределенными. В настоящем исследовании мы стремились выяснить, можно ли спрогнозировать возникновение ХО у детей с ТП по клиническим параметрам.

Методы

Методы. Мы провели ретроспективный анализ 47 случаев острого отторжения трансплантата печени у детей, прооперированных в больнице Намази (г. Шираз, Иран) в период с 2007-го по 2017 год.

Результаты

Результаты. В исследование включили 47 детей: 22 (46,8%) мальчика и 25 (53,2%) девочек. Асцит, желудочно-кишечное кровотечение и спонтанный бактериальный перитонит наблюдались в 20 (44,4%), 14 (31,1%) и 4 (9,1%) случаях соответственно. Посттрансплантационные сосудистые и билиарные осложнения отмечались в 3 (7%) и 4 (9,3%) случаях соответственно. Показатели печеночных ферментов нормализовались в среднем через 14,2 ± 7,5 дня после ТП. Среднее количество эпизодов острого отторжения составило 1,4 ± 0,6 (медиана = 1 (22; 46,8%), диапазон 1–3). У 6 (12,7%) пациентов наблюдалось ХО. Среднее время от ТП до ХО составило 75 ± 28,4 дня. Мы выявили статистически значимую корреляцию между ХО и предоперационным периодом (нахождение в стационаре или амбулаторная подготовка, р = 0,03). ХО статистически значимо коррелировало с наличием билиарных осложнений (р = 0,01), другие послеоперационные факторы статистически значимо на него не влияли. Билиарные осложнения (ОР = 33,7, 95% ДИ 2,2–511, р = 0,01) и предоперационный статус пациента (ОР = 10,9, 95% ДИ 1,1–102,5, р = 0,03) значительно повышали риск ХО.

Заключение

Заключение. Госпитализация при подготовке к трансплантации и раннее выявление билиарных осложнений могут предотвратить развитие ХО трансплантата у детей после ТП.

Background

Background. Chronic graft rejection (CR) represents an increasing concern in pediatric liver transplantation (LT). Risk factors of CR in this population are uncertain. In present study, we aimed to ascertain if clinical parameters could predict the occurrence of CR in LT children.

Methods

Methods. We retrospectively analyzed the results from 47 children who had experienced acute hepatic rejection in Namazee hospital, Shiraz, Iran during 2007–2017.

Results

Results. Out of 47 children, 22 (46.8%) and 25 (53.2%) were boys and girls respectively. Ascites, gastrointestinal bleeding, and spontaneous bacterial peritonitis were observed in 20 (44.4%), 14 (31.1%), and 4 (9.1%) respectively. Posttransplant vascular and biliary complications were observed in 3 (7%) and 4 (9.3%) cases respectively. The mean time from LT to normalization of liver enzymes was 14.2 ± 7.5 days. The mean of acute rejection episodes was 1.4 ± 0.6 (median = 1 (22, 46.8%), range of 1–3). Six (12.7%) patients experienced CR. The mean time from LT to CR was 75 ± 28.4 days. A significant association was found between CR and patients’ condition (being inpatient or outpatient) before surgery (P = 0.03). No significant relationship was found between CR and post-transplant parameters except for biliary complications (P = 0.01). Both biliary complication (RR = 33.7, 95% CI: 2.2–511, P = 0.01) and inpatient status (RR = 10.9, 95% CI: 1.1–102.5, P = 0.03) significantly increased the risk of CR.

Conclusion

Conclusion. Being hospitalized at the time of LT, and development of biliary complications might predict risk factors for development of CR in LT children.

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The authors declare that there are no conflicts of interest present.