Ferraz-Neto B H, Zurstrassen M P V C, Hidalgo R, Rezende M B, Meira-Filho S P, Pandullo F L, Fonseca L E P, Pereira L A, Afonso R C
Liver Transplant Team, Figado-HIAE, Albert Einstein Hospital, Av. Albert Einstein 627-701, CEP 05652-900 São Paulo, SP, Brazil.
Transplant Proc. 2006 Jul-Aug;38(6):1911-2. doi: 10.1016/j.transproceed.2006.06.073.
The treatment of end-stage liver disease includes transplantation as a life-saving procedure although it has serious complications of hepatic artery thrombosis, liver dysfunction, or primary nonfunction, which frequently lead to the need for retransplantation. According to various reports, the incidence of retransplantation is around 10%. Given the critical organ shortage, the chance for a second transplant remains a controversial discussion in medical, ethical, and economic grounds because patient and graft survival rates after retransplantation are lower than those for primary transplantations. We retrospectively reviewed all of the urgent liver retransplants from October 2001 to February 2005 (52 months) by analyzing the number of retransplants, blood group, time between first and second liver transplantation, age, sex, and mortality. Data were obtained from the Transplantation System, State of Sao Paulo Health Secretariat. Among 1252 liver transplants performed during this period, 98 (7.82%) were urgent retransplantations. The primary procedure employed 955 (76.28%) deceased donors and 297 (23.72%) living donors. All 98 retransplants were performed using an organ from the pool of deceased donors. The retransplant rate was acceptable according to the literature, although we observed high rates of early mortality (<60 days), leading to a discussion of which patients had a better chance of survival and the best time to perform the second transplantation to use this scarce and precious resource in the best possible way.
终末期肝病的治疗包括将肝移植作为一种挽救生命的手术，尽管该手术存在肝动脉血栓形成、肝功能障碍或原发性无功能等严重并发症，这些并发症常常导致需要再次移植。根据各种报告，再次移植的发生率约为10%。鉴于关键器官短缺，二次移植的机会在医学、伦理和经济层面仍是一个有争议的话题，因为再次移植后的患者和移植物存活率低于初次移植。我们通过分析再次移植的数量、血型、首次和第二次肝移植之间的时间、年龄、性别和死亡率，对2001年10月至2005年2月（52个月）期间所有紧急肝再次移植进行了回顾性研究。数据来自圣保罗州卫生秘书处的移植系统。在此期间进行的1252例肝移植中，98例（7.82%）为紧急再次移植。初次手术使用了955例（76.28%）脑死亡供体和297例（23.72%）活体供体。所有98例再次移植均使用脑死亡供体库中的器官。根据文献，再次移植率是可以接受的，尽管我们观察到早期死亡率（<60天）较高，这引发了关于哪些患者有更好的生存机会以及进行第二次移植的最佳时机的讨论，以便以最佳方式利用这种稀缺而宝贵的资源。
