Shen Zhong-Yang, Zhu Zhi-Jun, Deng Yong-Lin, Zheng Hong, Pan Cheng, Zhang Ya-Ming, Shi Rui, Jiang Wen-Tao, Zhang Jian-Jun
Orient Organ Transplant Center, First Central Hospital, Tianjin 300192, China.
Hepatobiliary Pancreat Dis Int. 2006 May;5(2):180-4.
Because the orthotopic liver transplantation (OLT) was performed widely in recent 5 years throughout China, the proportion of recipients whose graft function deteriorated to be retransplantation candidates increased gradually. This study was undertaken to analyze clinical experience of orthotopic liver retransplantation (re-OLT) at our center.
The medical records of 80 patients who had undergone liver retransplantation at our center from January 1999 to July 2005 were analyzed retrospectively, including indications and timing of retransplantation, surgical techniques, and the causes of death.
The commonest cause leading to hepatic graft loss and subsequent retransplantation was biliary complications in 36 patients (45%). The patients underwent retransplantation more than 30 days after their primary transplant recovered better than those who underwent retransplantation within 8-30 days after primary transplantation (perioperative mortality 19.6% versus 70%). Sepsis (12 of 22 patients, 54.5%) and multiple organ failure (4 of 22 patients, 18.2%) were leading causes of re-OLT recipient deaths.
Proper indications and optimal operative time, surgical procedures, perioperative monitoring and appropriate postoperative treatment contribute to the improvement of the survival rate of patients after liver retransplantation.
近5年来，原位肝移植（OLT）在我国广泛开展，移植肝功能恶化需再次移植的受者比例逐渐增加。本研究旨在分析我院原位肝再次移植（re-OLT）的临床经验。
回顾性分析1999年1月至2005年7月在我院接受肝再次移植的80例患者的病历，包括再次移植的适应证、时机、手术技术及死亡原因。
导致肝移植失功及再次移植的最常见原因是胆道并发症，共36例（45%）。首次移植后30天以上接受再次移植的患者比首次移植后8至30天内接受再次移植的患者恢复更好（围手术期死亡率分别为19.6%和70%）。脓毒症（22例中的12例，54.5%）和多器官功能衰竭（22例中的4例，18.2%）是再次肝移植受者死亡的主要原因。
合适的适应证、最佳手术时机、手术方式、围手术期监测及恰当的术后治疗有助于提高肝再次移植患者的生存率。
