Meneu-Diaz J C, Moreno Gonzalez E, Moreno Elola-Olaso A, Lopez E Vicente, Nuño Vazquez J, Jimenez C, Turrion V, Loinaz C, Gomez R, Abradelo M
University Hospital 12 de Octubre, Department of General, Digestive and Abdominal Organs Transplantation, Madrid, Spain.
Hepatogastroenterology. 2003 Nov-Dec;50(54):2143-8.
BACKGROUND/AIMS: In order to establish a rational strategy for organ distribution and optimal patient management, we postulate it is mandatory not only to understand the pathophysiology of failing grafts but also to better recognize the baseline clinical characteristics of the recipients shortly before receiving a second liver allograft.
Between March 1986 and December 1997, 1061 patients underwent 1087 orthotopic liver transplantation at three Hospitals in Madrid (122 retransplants).
Mean follow-up was 36 months (range, 1-90), 40.6% of the recipients were alive and survival at 1, 3 and 5 years was 62%, 53%, and 46%. Almost 50% of the recipients were UNOS 1 before retransplantation. In comparison to p-OLT (15% UNOS 1), it is clearly shown that the retransplants have been performed in the sickest patients with more adverse prognostic indicators (higher AST, bilirubin, creatinine serum levels, higher Child-Pugh score, higher rate of ascites and lower serum levels of albumin and prothrombin activity).
Liver retransplantation is acceptable and significant differences in recipients' baseline characteristics suggest an impact on lower survival.
背景/目的：为了制定合理的器官分配策略和优化患者管理，我们假定不仅必须了解移植肝失功的病理生理学，还必须更好地认识接受再次肝移植前受者的基线临床特征。
1986年3月至1997年12月期间，马德里的三家医院有1061例患者接受了1087例原位肝移植（其中122例为再次移植）。
平均随访36个月（范围1 - 90个月），40.6%的受者存活，1年、3年和5年生存率分别为62%、53%和46%。几乎50%的受者在再次移植前属于美国器官共享联合网络（UNOS）1级。与初次肝移植（15%为UNOS 1级）相比，显然再次移植是在病情最重、预后指标更差的患者中进行的（天门冬氨酸氨基转移酶、胆红素、肌酐血清水平更高，Child-Pugh评分更高，腹水发生率更高，白蛋白和凝血酶原活性血清水平更低）。
肝再次移植是可行的，受者基线特征的显著差异表明其对较低生存率有影响。
