儿童肝移植术后免疫耐受的临床特点

摘要

目的 探讨儿童肝移植术后免疫耐受的临床特点,寻找可能的预测指标.方法 对重庆医科大学附属儿童医院接受肝移植手术的37例患儿的临床资料进行回顾性分析.这些患儿肝移植术后均随访3年以上.根据目前免疫抑制剂用药情况,分为完全停药组(n =4)、单药组(n=16)和多药组(n=17),根据临床资料筛选可能的影响因素并对其进行统计学分析.统计分析采用Fisher确切概率检验和多个独立样本秩和检验.结果 37例受者中男性16例(43.2％),女性21例(56.8％).接受肝移植时的中位年龄为7.6个月(四分位距,5.9 ～29.8个月).心脏死亡器官捐献(DCD)肝移植10例(27.0％),亲体活体肝移植27例(73.0％).供者中位年龄为29.9岁(四分位距,22.5 ～ 35.9岁).各组间存在差异的因素包括受者移植年龄、ALT和AST.单药组与多药组受者移植年龄以及ALT、AST水平差异有统计学意义(均P＜0.05).完全停药组与多药组仅ALT水平差异有统计学意义(P＜0.05).完全停药组与单药组各因素无显著差异.结论 受者移植年龄可能是影响小儿肝移植临床免疫耐受形成的潜在因素,ALT、AST可以作为预测肝移植术后免疫耐受形成的潜在指标.%Objective To study the clinical characteristics of immune tolerance after liver transplantation in children and to identify possible predictors.Methods The clinical data of 37 pediatric patients who underwent liver transplantation between April 2006 and April 2014 at the Children's Hospital of Chongqing Medical University were retrospectively analyzed.The patients were divided into the no-drug (n =4),single-drug (n =16) and multi-drug (n =17) groups according to the status of their current immunosuppressant medications.The possible predictive factors were screened based on their clinical data,and statistical analysis was performed.Results The 37 liver transplantation recipients included 16 males (43.2％) and 21 females (56.8％).The factors that differed among the groups included age at transplantation and the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of the transplant recipients.Age,ALT level,and AST level of the transplant recipients were significantly different between the single-drug group and the multi-drug group (all P ＜ 0.05).However,only the ALT Ievel was significantly different (P ＜ 0.05) between the no-drug group and the multi-drug group.No significant differences were found in the various other factors between the no-drug and single-drug groups.Conclusion The age of the recipient at transplantation was a predictive factor affecting clinical immune tolerance in pediatric liver transplantation,while ALT and AST levels were potential predictors of postoperative immune tolerance.