Shan Yuhua,Gu Song,Xu Min,et al.Differentiation and prognosis of intestinal obstruction after pediatric liver transplantation[J].Journal of Clinical Pediatric Surgery,,20():576-581,587.[doi:10.12260/lcxewkzz.2021.06.013]
Differentiation and prognosis of intestinal obstruction after pediatric liver transplantation
- Keywords:
- Liver Transplantation/MT; Postoperative Complications; Intestinal Obstruction; Posttransplant Lymphoproliferative Disorder; Intestinal Perforation
- CLC:
- R617;R725.742;R656.622
- Abstract:
- Objective To explore the cause and prognosis of intestinal obstruction after liver transplantation (LT) in children and explore the suggestive factors of etiology.Methods A retrospective analysis was performed for 30 children hospitalized with intestinal obstruction after LT from 2013 to 2018.Results The etiologies included posttransplant lymphoproliferative disorder (PTLD,n=8),gastrointestinal perforation due to surgical trauma (n=5),adhesive intestinal obstruction (n=10),diaphragmatic hernia (n=2) and spontaneous peritonitis (n=5).Fifteen children underwent exploratory laparotomy.The overall survival rate was 73.33%.The causes of death were PTLD (n=4),severe infection after perforation (n=3) and spontaneous peritonitis caused by systematic infection (n=1).The average occurring time was (13.4±10.5) months after LT for PTLD,(3.14±3.18) months for adhesive intestinal obstruction,(6.00±6.16) days for spontaneous peritonitis and (8.00±4.18) days for perforation.The cause of posttransplant intestinal obstruction occurring within 3 months or not could be predicted by receiver operating characteristic (ROC) curve of onset time and the area under curve (AUC) was 1.000 (P<0.0001);PTLD and adhesive intestinal obstruction could be differentiated by onset time and AUC was 0.856 (P=0.011).Conclusion PTLD and perforation are important causes of death.And different occurring times may hint at the cause.
References:
1 Pham YH,Miloh T.Liver transplantation in children[J].Clin Liver Dis,2018,22(4):807-821.DOI:10.1016/j.cld.2018.06.004.
2 Rawal N,Yazigi N.Pediatric Liver Transplantation[J].Pediatr Clin North Am,2017,64(3):677-684.DOI:10.1016/j.pcl.2017.02.003.
3 Blachar A,Federle MP.Bowel obstruction following liver transplantation:clinical and ct findings in 48 cases with emphasis on internal hernia[J].Radiology,2001,218(2):384-388.DOI:10.1148/radiology.218.2.r01ja22384.
4 Davis SE,Sperling L.Obstruction of the Small Intestine[J].Arch Surg,1969,99(4):424-426.DOI:10.1001/archsurg.1969.01340160004002.
5 Yoeli D,Ackah RL,Sigireddi RR,et al.Reoperative complications following pediatric liver transplantation[J].J Pediatr Surg,2018,53(11):2240-2244.DOI:10.1016/j.jpedsurg.2018.04.001.
6 Earl TM,Wellen JR,Anderson CD,et al.Small bowel obstruction after pediatric liver transplantation:the unusual is the usual[J].J Am Coll Surg,2001,212(1):62-67.DOI:10.1016/j.jamcollsurg.2010.09.017.
7 Karakoyun M,?nen ?,Baran M,et al.Post-transplant malignancies in pediatric liver transplant recipients:Experience of two centers in Turkey[J].Turk J Gastroenterol,2018,29(1):89-93.DOI:10.5152/tjg.2017.17089.
8 Eshraghian A,Imanieh MH,Dehghani SM,et al.Post-transplant lymphoproliferative disorder after liver transplantation:Incidence,long-term survival and impact of serum tacrolimus level[J].World J Gastroenterol,2017,23(7):1224-1232.DOI:10.3748/wjg.v23.i7.1224.
9 Hsu CT,Chang MH,Ho MC,et al.Post-transplantation lymphoproliferative disease in pediatric liver recipients in Taiwan[J].Med Assoc,2019,118(11):1537-1545.DOI:10.1016/j.jfma.2018.12.023.
10 Bar?? Z,?z?ay F,Y?lmaz ?zbek ?,et al.A single-center experience of post-transplant lymphoproliferative disorder (PTLD) cases after pediatric liver transplantation:Incidence,outcomes,and association with food allergy[J].Turk J Gastroenterol,2018,29(3):354-360.DOI:10.5152/tjg.2018.17731.
11 Martin-Moreno PL,Panizo C.Update on posttransplant lymphoproliferative disease[J].Curr Opin Nephrol Hypertens,2018,27(6):440-444.DOI:10.1097/MNH.0000000000000457.
12 Chiou FK,Beath SV,Morland B,et al.Comparison of clinical features and outcome of pediatric post-transplant lymphoproliferative disorder in recipients of small bowel allograft versus isolated liver transplantation[J].Transplantation,2019.DOI:10.1097/TP.0000000000003004.
13 Ballova V,Muoio B,Albano D,et al.Diagnostic performance of (18)F-FDG PET or PET/CT for detection of post-transplant lymphoproliferative disorder:a systematic review and a bivariate Meta-analysis[J].Diagnostics (Basel),2020,10(2):E101.DOI:10.3390/diagnostics10020101.
14 Shoji K,Funaki T,Kasahara M,et al.Risk factors for bloodstream infection after living-donor liver transplantation in children[J].Pediatr Infect Dis J,2015,34(10):1063-1068.DOI:10.1097/INF.0000000000000811.
15 Mu J,Chen Q,Zhu L,et al.Influence of gut microbiota and intestinal barrier on enterogenic infection after liver transplantation[J].Curr Med Res Opin,2019,35(2):241-248.DOI:10.1080/03007995.2018.1470085.
16 Dever JB,Sheikh MY.Review article:spontaneous bacterial peritonitis-bacteriology,diagnosis,treatment,risk factors and prevention[J].Aliment Pharmacol Ther,2015,41(11):1116-1131.DOI:10.1111/apt.13172.
17 韩环立,张明满,郭春宝,等.胆道闭锁肝移植术后早期肝动脉血栓的诊断及处理[J].临床小儿外科杂志,2017,16(2):138-141,150.DOI:10.3969/j.issn.1671-6353.2017.02.008%W. Han HL,Zhang MM,Guo CB,et al.Diagnosis and treatment of early-stage hepatic artery thrombosis after liver transplantation for biliary atresia[J].J Clin Ped Sur,2017,16(2):138-141,150.DOI:10.3969/j.issn.1671-6353.2017.02.008%W.
18 Levi M,Schultz M,van der Poll T.Sepsis and thrombosis[J].Semin Thromb Hemost,2013,39(5):559-566.DOI:10.1055/s-0033-1343894.
19 Iba T,Levy JH.Inflammation and thrombosis:roles of neutrophils,platelets and endothelial cells and their interactions in thrombus formation during sepsis[J].J Thromb Haemost,2018,16(2):231-241.DOI:10.1111/jth.13911.
20 Wang K,Gao W,Ma N,et al.Acquired diaphragmatic hernia in pediatrics after living donor liver transplantation:Three cases report and review of literature[J].Medicine (Baltimore),2018,97(15):e0346.DOI:10.1097/MD.0000000000010346.
21 Yilmaz M,Akbulut S,Yilmaz S.Gastrointestinal perforation after liver transplant:a single center experience[J].Exp Clin Transplant,2017,15(2):10.DOI:10.6002/ect.2012.0061.
22 Dehghani SM,Nikeghbalian S,Kazemi K,et al.Outcome of bowel perforation after pediatric liver transplantation[J].Pediatr Transplant,2008,12(2):146-149.DOI:10.1111/j.1399-3046.2007.00829.x.
23 Schwarz C,Soliman T,Gy?ri G,et al.Abdominal drainage after liver transplantation from deceased donors[J]. Langenbecks Arch Surg, 2015, 400(7):813-819.DOI:10.1007/s00423-015-1338-3.
24 Li Y,Song J,Lin N,et al.Computed tomography scan is superior to x-ray plain film in the diagnosis of gastrointestinal tract perforation[J].Am J Emerg Med,2015,33(3):480.e3-e5.DOI:10.1016/j.ajem.2014.08.048.
Memo
收稿日期:2020-02-16;。
基金项目:上海市抗癌协会雏鹰计划（编号：SACA—CY20C11）
通讯作者:严志龙,Email:dryanzhilong@163.com