Marangoni Gabriele, Faraj Walid, Sethi Harsheet, Rela Mohamed, Muiesan Paolo, Heaton Nigel
King's College London School of Medicine at King's College Hospital, Institute of Liver Studies, Denmark Hill, SE59RS London, UK.
Hepatobiliary Pancreat Dis Int. 2008 Dec;7(6):590-4.
Liver resection after liver transplantation is a relatively uncommon procedure. Indications for liver resection include hepatic artery thrombosis (HAT), non-anastomotic biliary stricture (ischemic biliary lesions), liver abscess, liver trauma and recurrence of hepatocellular carcinoma (HCC). Organ shortage and lower survival after re-transplantation have encouraged us to make attempts at graft salvage.
Eleven resections at a mean of 59 months after liver transplantation were made over 18 years. Indications for liver resection included HCC recurrence in 4 patients, ischemic cholangiopathy, segmental HAT, sepsis and infected hematoma in 2 each, and ischemic segment IV after split liver transplantation in 1.
There was no perioperative mortality. Morbidity included one re-laparotomy for small bowel perforation, one bile leak treated conservatively, one right subphrenic collection, one wound infection and 5 episodes of Gram-negative sepsis. One patient underwent re-transplantation 4 months after resection for chronic rejection. There were 3 deaths, two from HCC recurrence and one from post-transplant lymphoproliferative disorder. The overall mean follow-up after resection was 48 months.
Liver resection in liver transplant recipients is safe, and has good outcome in selected patients and avoids re-transplantation in the majority of patients. Recipients with recurrent HCC in graft may benefit from resection, but cure is uncommon.
肝移植后肝切除术是一种相对不常见的手术。肝切除的适应证包括肝动脉血栓形成（HAT）、非吻合口胆管狭窄（缺血性胆管病变）、肝脓肿、肝外伤和肝细胞癌（HCC）复发。器官短缺以及再次移植后生存率较低促使我们尝试挽救移植物。
在18年期间，对肝移植术后平均59个月的患者进行了11例肝切除术。肝切除的适应证包括4例HCC复发、2例缺血性胆管病、2例节段性HAT、2例脓毒症和感染性血肿，以及1例活体肝移植后IV段缺血。
围手术期无死亡病例。并发症包括1例因小肠穿孔再次剖腹手术、1例保守治疗的胆漏、1例右膈下积液、1例伤口感染和5次革兰阴性菌脓毒症发作。1例患者在切除术后4个月因慢性排斥反应接受再次移植。有3例死亡，2例死于HCC复发，1例死于移植后淋巴细胞增生性疾病。切除术后的总体平均随访时间为48个月。
肝移植受者行肝切除术是安全的，在特定患者中效果良好，且在大多数患者中可避免再次移植。移植肝发生HCC复发的受者可能从切除术中获益，但治愈并不常见。
