Selvaggi G, Weppler D, Nishida S, Moon J, Levi D, Kato T, Tzakis A G
Division of Liver and GI Transplantation, University of Miami Miller School of Medicine, Miami, Florida, USA.
Am J Transplant. 2007 Feb;7(2):454-60. doi: 10.1111/j.1600-6143.2006.01649.x. Epub 2007 Jan 4.
Porto-caval hemitransposition (PCH) in liver transplantation allows revascularization of the liver when the porto-mesenteric axis is thrombosed. We, here, review our experience over an 11-year period. A total of 23 patients underwent liver transplantation using PCH. Immunosuppression was based on tacrolimus, with sirolimus used in case of renal insufficiency. Most common diagnoses were hepatitis C, Laennec's, Budd-Chiari and cryptogenic cirrhosis. Six patients needed splenectomy prior to transplant, 5 during transplant, 1 post-transplant, 11 had no splenectomy. Overall survival was 60% at 1 year and 38% at 3 years, with 10 of 23 patients currently alive and the longest survivor at 9.3 years. Most common cause of death was sepsis/multisystem organ failure, followed by pulmonary embolism. A total of 7/23 patients experienced post-operative gastrointestinal bleeding episodes, 6/23 patients developed thrombosis of the vena cava (median 162 days post-op). Post-operative ascites was noted in almost all patients. Renal dysfunction was commonly seen even after the first month post-transplant. PCH offers a feasible option for liver transplantation in those patients with complex thrombosis of the mesenteric and portal circulation.
肝移植中的门腔半转位（PCH）可在门静脉肠系膜轴血栓形成时实现肝脏的血管重建。在此，我们回顾了我们11年间的经验。共有23例患者接受了采用PCH的肝移植手术。免疫抑制以他克莫司为基础，肾功能不全时加用西罗莫司。最常见的诊断为丙型肝炎、Laennec肝硬化、布加综合征和隐源性肝硬化。6例患者在移植前需要行脾切除术，5例在移植术中，1例在移植后，11例未行脾切除术。1年总生存率为60%，3年为38%，23例患者中有10例目前存活，最长存活者达9.3年。最常见的死亡原因是败血症/多系统器官衰竭，其次是肺栓塞。23例患者中有7例发生术后胃肠道出血，23例患者中有6例发生腔静脉血栓形成（术后中位时间162天）。几乎所有患者术后均出现腹水。即使在移植后第一个月后也常见肾功能障碍。对于肠系膜和门静脉循环存在复杂血栓形成的患者，PCH为肝移植提供了一种可行的选择。
