儿童肝移植受者原发性硬化性胆管炎复发的危险因素:荟萃分析

IF 1.7 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Bei Sun, Dong Guan, Yu-Geng Gao, Jing-Yi Chen, Yi-Hui Rong, Zuo-Ming Guo
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摘要

背景:原发性硬化性胆管炎(PSC)是一种以胆管炎症和瘢痕形成为特征的长期肝脏疾病,可导致肝硬化、门脉高压和胆管癌等并发症。虽然PSC主要影响成人,但儿科患者的发病率正在上升。对于肝病晚期患者,肝移植(LT)是唯一的治疗选择。然而,移植肝中PSC的复发,即复发性PSC (rPSC),仍然是一个值得关注的问题。目的:确定小儿lt术后PSC复发的潜在危险因素。方法:检索PubMed、Embase、Cochrane Library和Scopus等数据库的文献,涵盖1990年至2024年发表的研究。纽卡斯尔-渥太华量表用于评估所选研究的质量。采用RevMan 5.3软件进行统计学分析,采用95%CI的风险比(HR)量化复发风险。结果:本分析共纳入9份报告,共2524例小儿PSC患者。研究结果揭示了与接受肝移植的儿科患者rPSC相关的几个重要危险因素,包括并发炎症性肠病(IBD)、肝酶水平升高以及psc -自身免疫性肝炎(AIH)重叠综合征的存在(均P < 0.05)。在儿童肝移植受者中,急性同种异体移植排斥反应、eb病毒感染与rPSC复发风险之间没有统计学意义的关联。结论:本系统综述和荟萃分析确定了与行肝移植的儿科患者PSC复发相关的各种危险因素,包括IBD、肝酶水平升高和PSC- aih重叠综合征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk factors for recurrence of primary sclerosing cholangitis in pediatric liver transplant recipients: A meta-analysis.

Background: Primary sclerosing cholangitis (PSC) is a long-term liver condition defined by the inflammation and scarring of the bile ducts, resulting in complications such as liver cirrhosis, portal hypertension, and cholangiocarcinoma. Although PSC predominantly affects adults, the incidence in pediatric patients is rising. For individuals in the advanced stages of liver disease, liver transplantation (LT) is the sole curative treatment option. However, the recurrence of PSC in the transplanted liver, known as recurrent PSC (rPSC), remains a significant concern.

Aim: To identify the potential risk factors for the recurrence of PSC in pediatric patients after undergoing LT.

Methods: A literature search was carried out across databases, including PubMed, Embase, Cochrane Library, and Scopus, covering studies published from 1990 through 2024. The Newcastle-Ottawa scale was utilized to assess the quality of the selected studies. Statistical analyses were conducted using RevMan 5.3 software, where the risk of recurrence was quantified using hazard ratios (HR) with 95%CI.

Results: A total of nine reports with 2524 pediatric patients with PSC were included in this analysis. The findings revealed several important risk factors connected to the rPSC in pediatric patients who had received a liver transplant, including concurrent inflammatory bowel disease (IBD), elevated liver enzyme levels, and the presence of PSC-autoimmune hepatitis (AIH) overlap syndrome (all P < 0.05). No statistically significant association was found between acute allograft rejection, Epstein-Barr virus infection, and the risk of rPSC recurrence in the pediatric liver transplant recipients.

Conclusion: The present systematic review and meta-analysis have identified various risk factors associated with the recurrence of PSC in pediatric patients who underwent LT, including IBD, elevated liver enzyme levels, and PSC-AIH overlap syndrome.

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