急性肝功能衰竭（ALF）的患者行活体供者肝移植（LDLT）依然存在争议。为了明确其为一种可行的选择方案，该治疗方法需要显示其与尸体供者肝移植有同样的疗效，且对于供者没有明显的风险。该研究的目的在于比较儿童ALF的患者接受尸体供者和活体供者后的预后。患者和方法：从1994年3月至2007年2月，149名18岁一下的患者接受了肝脏移植，其中有43例患者（28.8%）为ALF。我们回顾了这些患者的人口统计学、病因学、外科手术的技术、并发症以及长期结果。采用荟萃分析精确计算了患者的生存率。结果：受者的平均年龄为4.8岁（范围为1.2到18岁），其中包括26名男孩和17名女孩。16名患者（37.2%）为LDLT。3名活体供肝的患者需要再次移植（18.7%），而尸体供者组为7例（26%）。活体供者没有死亡或者严重的疾病发生。55名患者死亡。脓毒血症以及神经系统并发症以及原发性的移植物无功能是导致死亡的最常见原因。所有死亡的患者均在移植后1年内死亡。实际1年和5年患者生存率均为65%，两组间没有显著性差异。结论：考虑到ALF的患者除了进行肝移植外没有生存的可能，且我国尸体供者依然短缺，这些结果显示LDLT是这些患者的有效选择，且对于供者的安全有保障。

Living donor liver transplantation in pediatric patients with acute liver failure: safe and effective alternative.

Uribe M, González G, Alba A, Godoy J, Ferrario M, Hunter B, Iñiguez R, Cavallieri S, Díaz V, Macho L, Ferrón S, Buckel E.

Liver Transplant Program Clínica Las Condes, Hospital Luis Calvo Mackenna, Santiago, Chile.

Living donor liver transplantation (LDLT) for patients with acute liver failure (ALF) is still controversial. To be considered a feasible alternative, this therapeutic option should offer similar results to transplants performed with cadaveric grafts, without significant risks for donors. The aim of this study was to compare the outcomes of pediatric patients with ALF who were transplanted with either cadaveric or living donor grafts. PATIENTS AND METHODS: Between March 1994 and February 2007, 149 patients under 18 years were transplanted, including 43 (28.8%) with ALF. We reviewed the demography, etiology, surgical technique, complications, and long-term results in this group. Patient actuarial survival was determined by Kaplan-Meier analysis. RESULTS: The median age of the recipients was 4.8 years (range 1.2 to 18) including 26 boys and 17 girls. Sixteen (37.2%) underwent LDLT. Three patients in the living donor group needed a second graft (18.7%) versus 7 (26%) among the cadaveric group. No mortality or serious morbidity was observed in living donors. Fifteen patients died. Septic and neurologic complications, and primary graft non-function were the most frequent causes of death. All patients died during the first year after liver transplant. Actuarial 1- and 5-year survivals were 65% without a significant difference between the groups. CONCLUSION: Considering that patients with ALF have no chance of survival without transplantation and that cadaveric grafts remain a limited resource, especially in our country, these results showed that LDLT was a valid option for these patients, as well as a secure procedure for the donors.