Abstract:

Objective To explore the risk factors for massive blood loss during pediatric living donor livertransplantation（LDLT）and their impact on prognosis. Methods A retrospective analysis was conducted on theclinical data of 43 pediatric patients who underwent LDLT between August 2014 and December 2024 at the Department ofPediatric Surgery， First Affiliated Hospital of Xinjiang Medical University. Among the patients，20 cases were male and 23 cases were female， the mean age was 5.9（5） years（range ：0.42 ~ 15 years）and the mean weight was 20.5（14.6）kg （range ：4.93 ~ 50 kg）. The primary diagnoses included 14 cases of biliary atresia，9 cases of Wilson's disease，5 cases of portal vein cavernous transformation， and 15 cases of other liver diseases. Massive blood loss（estimated blood loss， EBL）was defined as blood loss exceeding one circulating blood volume within 24 h. Patients were divided into two groups ： themassive EBL group（8 cases）and the non-massive EBL group（33 cases）. Two patients with incomplete clinical data wereexcluded. Descriptive statistical analysis was used to assess patient characteristics and surgical details. Univariate logisticregression was performed to identify factors associated with massive EBL， and χ2 tests were used to compare the incidence of portal vein complications between the two groups. Kaplan-Meier curves were utilized to compare the overall recipient and graft survival rates between the two groups. Results The incidence of intraoperative massive bleeding was 19.5%（8 cases）. Univariate logistic regression analysis revealed that the international normalized ratio （INR）， operation time， and cold ischemia time were significant factors associated with massive estimated blood loss （EBL） during liver transplantationin children with biliary atresia， and these factors also showed a significant correlation with intraoperative blood transfusion. χ²  tests showed that the incidence of postoperative complications， including respiratory infections， lymphatic leakage， andprimary non-function（PNF） of the graft were significantly different between the massive EBL group and non-massive EBL group. However， the cummulative overall survival rate and cummulative graft survival rate showed no significant differences between the two groups. Conclusion Higher preoperative INR， longer cold ischemia time， and extended surgical timemay significantly increase the risk of massive blood loss during pediatric liver transplantation. Strengthening preoperative coagulation function assessment and optimizing surgical procedures can help reduce the incidence of massive blood loss andimprove prognosis. 

Key words:

Children,  , Living donor liver transplantation,  , Bleeding,  , Risk factors,  , Prognosis

摘要：

目的 探究儿童亲体肝移植术中大出血的危险因素及对预后的影响。方法 回顾性分析 2014 年8 月至 2024 年 12 月在新疆医科大学第一附属医院小儿普外科进行亲体肝移植的 43 例患儿临床资料。其中男性 20 例，女性 23 例 ；受者年龄为 5.9（5）岁（范围 ：0.42 ~ 15 岁）；体重为 20.5（14.6）kg（范围 ：4.93 ~50 kg）。胆道闭锁患儿 14 例、肝豆状核变性 9 例、门静脉海绵样 5 例、其他肝脏疾病 15 例。将 24 h 内估计出血量（estimated blood loss，EBL）超过一个循环血容量定义为大出血，将患儿分为大量 EBL 组（8 例）与非大量 EBL 组（33 例），2 例临床数据不完整未纳入。采用描述性统计分析患者基本特征和手术情况，单因素 Logistic 回归分析探究发生大出血的相关因素，通过 χ2 检验比较两组患儿的门静脉并发症发生率。通过 Kaplan-Meier 曲线比较两组的总体生存率及移植物存活率。结果 术中大出血为 19.5%（8 例），单因素Logistics 回归显示 ：术前国际标准化比值 INR、手术时间、冷缺血时间是肝移植术中受体发生大量 EBL 的相关因素，且与术中输血存在明显相关性。χ2 检验显示 ：大量 EBL 组与非大量 EBL 组在术后呼吸道感染、淋巴漏与移植物原发性无功能（primary non function，PNF）的发生率存在显著差异。大量 EBL 组的累积总体生存率及累积总体移植物生存率较非大量 EBL 组无明显统计学差异。结论 术前较高的 INR、长冷缺血时间以及手术时间的延长可能会显著增加术中出血风险。加强术前凝血功能评估和优化手术流程有助于减少术中大出血的发生，改善预后。

关键词:

儿童 , 亲体肝移植 , 出血 , 危险因素 , 预后