北欧国家原发性硬化性胆管炎肝移植后的结果。

Outcome following liver transplantation for primary sclerosing cholangitis in the Nordic countries.

作者信息

Brandsaeter B, Friman S, Broomé U, Isoniemi H, Olausson M, Bäckman L, Hansen B, Schrumpf E, Oksanen A, Ericzon B G, Höckerstedt K, Mäkisalo H, Kirkegaard P, Bjøro K

机构信息

Dept. of Medicine, Rikshospitalet, Oslo, Norway.

出版信息

Scand J Gastroenterol. 2003 Nov;38(11):1176-83. doi: 10.1080/00365520310006009.

DOI:10.1080/00365520310006009

PMID:14686722

Abstract

BACKGROUND

Primary sclerosing cholangitis (PSC) is the most common indication for liver transplantation in the Nordic countries. Because these patients are difficult to evaluate with regard to timing of liver transplantation, it is important to establish predictors of post-transplant survival.

METHODS

Data from two groups of patients receiving liver allografts during 1982-2001 were recorded: (a) PSC patients and (b) comparison patients. Outcome following transplantation has been recorded for all patients. Regression analyses have been performed for PSC patients to analyse predictors of patient and graft survival.

RESULTS

A total of 245 PSC and 618 comparison patients received a first liver allograft in the period 1982 until the end of the study. The overall 1-, 3- and 5-year patient survival rates were 82%, 77% and 75%, and 80%, 77% and 74% in the PSC group and comparison group, respectively. Survival following transplantation has increased with time in both the PSC and the comparison group. Recent year of transplantation, no previous hepatobiliary surgery and a lower MELD score were predictors of survival following transplantation for PSC patients. PSC patients had a higher rate of re-transplantations (13% versus 8%, P = 0.01). Predictors of re-transplantation in PSC patients were an episode of early rejection and vascular thrombosis.

CONCLUSION

In PSC patients, year of transplantation, previous hepatobiliary surgery and MELD score are predictors of survival following transplantation and these patients are more frequently in need of re-transplantation compared to the comparison group.

摘要

背景

原发性硬化性胆管炎（PSC）是北欧国家肝移植最常见的适应证。由于这些患者在肝移植时机方面难以评估，因此建立移植后生存的预测指标很重要。

方法

记录了1982 - 2001年期间两组接受肝脏同种异体移植患者的数据：（a）PSC患者和（b）对照患者。记录了所有患者移植后的结局。对PSC患者进行了回归分析，以分析患者和移植物生存的预测指标。

结果

在1982年至研究结束期间，共有245例PSC患者和618例对照患者接受了首次肝脏同种异体移植。PSC组和对照组的1年、3年和5年总体患者生存率分别为82%、77%和75%，以及80%、77%和74%。PSC组和对照组的移植后生存率均随时间增加。近年移植、既往无肝胆手术史和较低的终末期肝病模型（MELD）评分是PSC患者移植后生存的预测指标。PSC患者再次移植的发生率更高（13%对8%，P = 0.01）。PSC患者再次移植的预测指标是早期排斥反应和血管血栓形成。