McMillan R W, Uppot R, Zibari G B, Aultman D F, Dies D F, McDonald J C
Louisiana State University Medical Center, School of Medicine, USA.
J La State Med Soc. 1999 Jul;151(7):367-72.
The development of orthotopic liver transplantation represents this century's most significant advance in the management of liver disease. In the 1980s the vast majority of liver transplants were performed at several large centers; however, in this decade, improvements in techniques and success rates have allowed live transplantation to expand to regional centers across the country, particularly in the southeast. This proliferation of regional centers and the widening disparity between organ availability and numbers of recipients have created tremendous controversy at the national level regarding the allocation scheme used to distribute livers to recipients. The large programs today are advocating change to a national waiting list which would eliminate local priority and jeopardize the existence of smaller regional centers. Furthermore, the large programs favor establishing a limited number of megacenters where all liver transplants would take place, arguing that low volume centers cannot perform liver transplants with acceptable complication and survival rates. At the Regional Transplant Center of Willis-Knighton Hospital and Louisiana State University Medical Center in Shreveport (WK/LSUMC) we performed 122 liver transplants between July 1, 1991 and December 31, 1997. The purpose of this study was to examine our complication and survival rates and compare them to national averages. The actuarial graft survival at 1, 2, and 3 years in this series compared to the national average respectively was 76% and 70%, 66% and 66%, 62% and 62%. The actuarial patient survival (WK/LSUMC vs National) at 1, 2, and 3 years was 80% and 80%, 75% and 75%, 70% and 74%. The rate of retransplantation was 8% with a national average of 10% to 20%. Our rate of graft primary non-function was 5% with the national average being 2% to 10%. The rate of vascular thrombosis of the graft in this series was 2% with a national rate of 5%. The differences in these results were not statistically significant (P < .05). Low volume transplant centers can perform liver transplant successfully, allowing the regionalization of the treatment of choice for end-stage liver disease.
原位肝移植的发展是本世纪肝脏疾病治疗领域最重大的进展。20世纪80年代，绝大多数肝移植手术在几个大型中心进行；然而，在这十年间，技术的改进和成功率的提高使得活体肝移植得以扩展至全国各地区域中心，尤其是东南部地区。区域中心的激增以及器官供应与受者数量之间日益扩大的差距，在全国范围内引发了关于肝脏分配给受者所用分配方案的巨大争议。如今的大型项目主张改为全国等候名单，这将消除地方优先权并危及较小区域中心的生存。此外，大型项目倾向于设立有限数量的大型中心，所有肝移植手术都将在这些中心进行，理由是低手术量中心无法以可接受的并发症发生率和生存率进行肝移植手术。在什里夫波特的威利斯 - 奈顿医院和路易斯安那州立大学医学中心区域移植中心（WK/LSUMC），我们在1991年7月1日至1997年12月31日期间进行了122例肝移植手术。本研究的目的是检查我们的并发症发生率和生存率，并与全国平均水平进行比较。该系列中1年、2年和3年的移植肝精算生存率与全国平均水平相比分别为76%和70%、66%和66%、62%和62%。1年、2年和3年的患者精算生存率（WK/LSUMC与全国水平相比）分别为80%和80%、75%和75%、70%和74%。再次移植率为8%，全国平均水平为10%至20%。我们的移植肝原发性无功能率为5%，全国平均水平为2%至10%。该系列中移植肝血管血栓形成率为2%，全国发生率为5%。这些结果的差异无统计学意义（P <.05）。低手术量移植中心能够成功进行肝移植手术，从而实现终末期肝病首选治疗的区域化。
