Ma Yi, Wang Guo-dong, He Xiao-shun, Li Jun-liang
Organ Transplantation Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Chin Med J (Engl). 2008 Oct 20;121(20):1987-91.
The curative effect of liver transplantation for patients with end-stage liver disease was encouraging in recent years and the 5-year patient survival rate can reach up to 70%. However, some patients might lose grafts due to a variety of reasons, including bile duct complications, vascular complications, primary non-function, graft rejection and disease recurrence etc. Liver retransplantation (re-LT) was the only available means for those patients whose initial grafts had failed, but the inferior outcomes of re-LT compared to primary liver transplantation (PLT) continue to be a major concern. This study aimed to analyze the indications for re-LT, optimal timing of re-LT, and strategies to improve the survival rate after re-LT.
From January 2001 to December 2006, we performed 738 liver transplants and 39 re-LT (5.3%) at our center. A retrospective analysis was performed to identify factors (indication for re-LT, preoperative score of model for end-stage liver disease (MELD), interval to re-LT from primary liver transplantation, methods of vascular and biliary reconstruction and common causes of death) associated with survival.
Mean follow-up period was 1.8 years (1 to 5 years). Patients with MELD score less than 20 were better than those whose MELD score was > 20 and MELD score > 30 (1-year survival, 80.0% versus 50.0% and 3/5). The perioperative survival rate of patients who received re-LT at an interval of more than 30 days and less than 8 days after the initial transplantation was higher than those who received retransplantation between 8 to 30 days following the first operation (88.5% and 74.3% versus 50.0%). The main causes of death were infection (60.0%), multiple organ failure (20.0%), vascular complications (10.0%) and biliary fistula (10.0%) in perioperative period. The overall patient survival rate of 1-month, 6-month and 1-year was 80.0%, 76.7% and 66.7%, respectively.
Our study suggested the favorable results after re-LT. The analysis also showed optimal timing of operation, refined surgical techniques, individualized immunosuppressive regimen and effective prophylaxis and treatment of perioperative infection play an important role in achieving a higher survival after re-LT.
近年来，肝移植治疗终末期肝病患者的疗效令人鼓舞，患者5年生存率可达70%。然而，部分患者可能因各种原因失去移植物，包括胆管并发症、血管并发症、原发性无功能、移植物排斥反应及疾病复发等。肝再次移植（re-LT）是初始移植物功能丧失患者的唯一可用治疗手段，但与初次肝移植（PLT）相比，re-LT效果较差仍是主要问题。本研究旨在分析re-LT的适应证、最佳时机及提高re-LT后生存率的策略。
2001年1月至2006年12月，我们中心共进行了738例肝移植手术，其中39例为re-LT（占5.3%）。进行回顾性分析，以确定与生存相关的因素（re-LT适应证、终末期肝病模型（MELD）术前评分、初次肝移植至re-LT的间隔时间、血管和胆管重建方法及常见死亡原因）。
平均随访时间为1.8年（1至5年）。MELD评分小于20的患者比MELD评分>20及MELD评分>30的患者预后好（1年生存率分别为80.0%、50.0%和3/5）。初次移植后间隔超过30天且少于8天接受re-LT的患者围手术期生存率高于初次手术后8至30天接受再次移植的患者（分别为88.5%、74.3%和50.0%）。围手术期死亡的主要原因是感染（60.0%）、多器官功能衰竭（20.0%）、血管并发症（10.0%）和胆瘘（10.0%）。患者1个月、6个月和1年的总体生存率分别为80.0%、76.7%和66.7%。
我们的研究表明re-LT后效果良好。分析还显示，最佳手术时机、精细的手术技术、个体化免疫抑制方案以及围手术期感染的有效预防和治疗对提高re-LT后的生存率起着重要作用。
