Szpakowski J L, Cox K, Nakazato P, Concepcion W, Levin B, Esquivel C O
Transplant Institute, California Pacific Medical Center, San Francisco.
West J Med. 1991 Nov;155(5):494-9.
Between March 1988 and November 1989, 100 liver transplants were performed on 90 patients at Pacific Presbyterian (now California Pacific) Medical Center in San Francisco. The immunosuppressive regimen was a combination of prophylactic Minnesota antilymphocyte globulin, cyclosporine, and low-dose corticosteroids. Rejections were treated with OKT3, a monoclonal antibody, or corticosteroids. Of the 100 transplants, 32 were done on 30 children, 18 of whom weighed less than 10 kg and 9 of whom received livers that had been surgically reduced in size to fit the recipient. The overall patient survival at 2 years was 85%. Of 100 liver transplants, treatment was given for 80 (80%) for at least 1 episode of rejection. At least 1 episode of serious infection occurred in 34 of the 60 adult patients and 25 of the 30 children. Of the entire group, 2% had hepatic artery thrombosis, and 12% had biliary complications that necessitated reoperation. The quality of life has been good, with a follow-up from 1 to almost 3 years (mean = 22 months). Comparing these data with those of other published series shows a decreased incidence of surgical complications and a lower rate of fungal and viral infections. We attribute this to the reduction of steroid dosage during convalescence without jeopardizing patient or graft survival.
1988年3月至1989年11月期间，旧金山太平洋长老会（现加利福尼亚太平洋）医疗中心为90名患者实施了100例肝脏移植手术。免疫抑制方案为预防性使用明尼苏达抗淋巴细胞球蛋白、环孢素和低剂量皮质类固醇联合使用。排斥反应采用OKT3（一种单克隆抗体）或皮质类固醇进行治疗。在这100例移植手术中，有32例是为30名儿童实施的，其中18名儿童体重不足10公斤，9名儿童接受了经手术缩小尺寸以适合受者的肝脏。患者2年总生存率为85%。在100例肝脏移植手术中，80例（80%）至少接受过1次排斥反应治疗。60名成年患者中有34例、30名儿童中有25例至少发生过1次严重感染。在整个组中，2%发生肝动脉血栓形成，12%发生需要再次手术的胆道并发症。生活质量良好，随访时间为1年至近3年（平均 = 22个月）。将这些数据与其他已发表系列的数据进行比较，结果显示手术并发症的发生率降低，真菌和病毒感染率也较低。我们将此归因于康复期间类固醇剂量的减少，而不影响患者或移植物的存活。
