急性肝衰竭的辅助性肝移植与原位肝移植。EURALT研究组。欧洲辅助性肝移植登记处。

Auxiliary versus orthotopic liver transplantation for acute liver failure. EURALT Study Group. European Auxiliary Liver Transplant Registry.

作者信息

van Hoek B, de Boer J, Boudjema K, Williams R, Corsmit O, Terpstra O T

机构信息

Department of Gastro-enterology & Hepatology, Leiden University Medical Center, The Netherlands.

出版信息

J Hepatol. 1999 Apr;30(4):699-705. doi: 10.1016/s0168-8278(99)80202-5.

DOI:10.1016/s0168-8278(99)80202-5

PMID:10207813

Abstract

BACKGROUND/AIMS/METHODS: We report 1-year results after auxiliary liver transplantation for acute liver failure in a cohort of 47 patients transplanted in 12 European centers as compared with those of 384 consecutive patients undergoing orthotopic liver transplantation for acute liver failure in the Eurotransplant area.

RESULTS

One-year patient survival resp. retransplant-free patient survival did not differ between orthotopic (61%, 232/384 resp. 52%, 200/384) and auxiliary liver transplantation (62%, 29/47 resp. 53%, 25/47). One-year patient survival resp. retransplant-free patient survival after auxiliary partial orthotopic liver transplantation was 71% (25/35) resp. 60% (21/35), not significantly different from orthotopic liver transplantation (61%, 232/384 resp. 52%, 200/384), while both transplantation techniques had better 1-year patient survival resp. retransplant-free patient survival than after heterotopic auxiliary liver transplantation (33%, 4/12) (p < 0.05). Primary nonfunction was more frequent after heterotopic auxiliary liver transplantation (3/12, 25%) than after orthotopic liver transplantation (21/384, 5.5%), while the incidence did not differ between orthotopic liver transplantation and auxiliary partial orthotopic liver transplantation (3/35, 8.5%). Portal vein thrombosis was more frequent after both heterotopic auxiliary liver transplantation (5/12, 42%) and auxiliary partial orthotopic liver transplantation (5/35, 14%) than after orthotopic liver transplantation (2/384, 0.5%) (p < 0.001). Of the patients, 65% (17/26) surviving auxiliary liver transplantation for 1 year without retransplantation by orthotopic liver transplantation were free of immunosuppression within 1 year, compared with none of the patients transplanted by orthotopic liver transplantation (p < 0.01).

CONCLUSIONS

Auxiliary liver transplantation, especially auxiliary partial orthotopic liver transplantation, offers an advantage over orthotopic liver transplantation in acute liver failure in terms of a chance of a life free of immunosuppression, apparently without jeopardizing chances of survival. Reduction of the incidence of primary nonfunction and vascular complications should be a focus of research in auxiliary liver transplantation. These findings need to be confirmed in a prospective study.

摘要

背景/目的/方法：我们报告了欧洲12个中心为47例急性肝衰竭患者进行辅助性肝移植的1年结果，并与欧洲移植区域384例接受原位肝移植治疗急性肝衰竭的连续患者的结果进行了比较。

结果

原位肝移植（61%，232/384；无再次移植的患者生存率为52%，200/384）和辅助性肝移植（62%，29/47；无再次移植的患者生存率为53%，25/47）的1年患者生存率及无再次移植的患者生存率无差异。辅助性部分原位肝移植后的1年患者生存率及无再次移植的患者生存率分别为71%（25/35）和60%（21/35），与原位肝移植（61%，232/384；无再次移植的患者生存率为52%，200/384）无显著差异，而这两种移植技术的1年患者生存率及无再次移植的患者生存率均高于异位辅助性肝移植（33%，4/12）（p<0.05）。异位辅助性肝移植后的原发性无功能发生率（3/12，25%）高于原位肝移植（21/384，5.5%），而原位肝移植与辅助性部分原位肝移植的发生率无差异（3/35，8.5%）。异位辅助性肝移植（5/12,42%）和辅助性部分原位肝移植（5/35,14%）后的门静脉血栓形成发生率均高于原位肝移植（2/384,0.5%）（p<0.001）。在接受辅助性肝移植且1年内未接受原位肝移植再次移植而存活的患者中，65%（17/26）在1年内无需免疫抑制，而原位肝移植患者无一例如此（p<0.01）。