Platz K P, Mueller A R, Spree E, Schumacher G, Nüssler N C, Rayes N, Glanemann M, Bechstein W O, Neuhaus P
Department of Surgery, Humboldt University of Berlin, Germany.
Transpl Int. 2000;13 Suppl 1:S127-30. doi: 10.1007/s001470050297.
Because of the donor shortage, there are concerns for liver transplantation in patients with alcoholic cirrhosis. We therefore analyzed patients transplanted for alcoholic cirrhosis at our center with respect to patient and graft survival, recurrence of disease, and postoperative complications. Out of 1000 liver transplantations performed in 911 patients, 167 patients were transplanted for alcoholic cirrhosis; 91 patients received CsA- and 76 patients FK506-based immunosuppression. Recurrence was diagnosed by patient's or relative's declaration, blood alcohol determination, and delirium. Diagnosis and treatment of acute and chronic rejection was performed as previously described. One- (96.8% versus 91.3%) and 9-year patient survival (83.3% versus 80%) compared well with other indications. Five of 15 patients died due to disease recurrence. Recurrence of disease was significantly related to the duration of alcohol abstinence prior to transplantation. In patients who were abstinent for less than 6 months (17.1%), recurrence rate was 65%, including four of the five patients who died of recurrence. Recurrence rate decreased to 11.8%, when abstinence time was 6-12 months and to 5.5%, when the abstinence times was > 2 years. Next to duration of abstinence, alcohol relapse was significantly related to sex, social environment, and psychological stability. The incidence of acute rejection compared well with other indications (38.1%); CsA: 40.1% versus 33.3% in FK506 patients. In all, 18.2% of CsA patients experienced steroid-resistant rejection compared with 2.6% of FK506 patients. Seven patients (7.6%) in the CsA group and one patient (1.3%) in the FK506 group developed chronic rejection. A total of 57.1% developed infections; 5.7% were life-threatening. CMV infections were observed in 14.3% (versus 25% for other indications). New onset of insulin-dependent diabetes was observed in 8.6% and hypertension in 32.4%. In conclusion, alcoholic cirrhosis is a good indication for liver transplantation with respect to graft and patient survival and development of postoperative complications. FK506 therapy was favourable to CsA treatment. Patient selection is a major issue and established criteria should be strictly adhered to. Patients with alcohol abstinence times shorter than 6 months should be excluded, since recurrence and death due to recurrence was markedly increased in this group of patients.
由于供体短缺，酒精性肝硬化患者的肝移植受到关注。因此，我们分析了在我们中心接受酒精性肝硬化肝移植的患者的受者和移植物存活情况、疾病复发情况以及术后并发症。在911例患者中进行的1000例肝移植中，167例患者因酒精性肝硬化接受移植；91例患者接受基于环孢素A（CsA）的免疫抑制治疗，76例患者接受基于他克莫司（FK506）的免疫抑制治疗。通过患者或其亲属的陈述、血液酒精测定以及谵妄来诊断复发情况。急性和慢性排斥反应的诊断和治疗按照先前描述的方法进行。1年（96.8%对91.3%）和9年的患者存活率（83.3%对80%）与其他适应证相比情况良好。15例患者中有5例死于疾病复发。疾病复发与移植前戒酒时间显著相关。在戒酒时间少于6个月的患者中（17.1%），复发率为65%，其中死于复发的5例患者中有4例在此组。当戒酒时间为6至12个月时，复发率降至11.8%，当戒酒时间超过2年时，复发率降至5.5%。除了戒酒时间外，酒精复饮与性别、社会环境和心理稳定性显著相关。急性排斥反应的发生率与其他适应证相比情况良好（38.1%）；CsA组：40.1%对FK506组的33.3%。总体而言，18.2%的CsA患者经历了激素抵抗性排斥反应，而FK506患者为2.6%。CsA组有7例患者（7.6%）发生慢性排斥反应，FK506组有1例患者（1.3%）发生慢性排斥反应。共有57.1%的患者发生感染；5.7%为危及生命的感染。巨细胞病毒感染发生率为14.3%（其他适应证为25%）。观察到8.6%的患者新发胰岛素依赖型糖尿病，32.4%的患者出现高血压。总之，就移植物和患者存活以及术后并发症的发生而言，酒精性肝硬化是肝移植的良好适应证。FK506治疗优于CsA治疗。患者选择是一个主要问题，应严格遵守既定标准。应排除戒酒时间短于6个月的患者，因为该组患者复发及因复发导致的死亡明显增加。
