Chen Gui-hua, Fu Bin-sheng, Yang Yang, Cai Chang-jie, Lu Min-qiang, Li Hua, Wang Gen-shu, Yi Shu-hong, Xu Chi, Zhang Jun-feng, Zhang Tong, Wang Guo-ying
Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
Chin Med J (Engl). 2008 Oct 20;121(20):1992-6.
Orthotopic liver retransplantation (re-OLT) is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT.
The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.
Biliary tract complications were the main indications for early re-OLT (57.1%) and late re-OLT (52.9%). Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease (MELD) score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma (HCC) in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups.
Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the improvement of overall survival rates of patients after re-OLT.
原位肝再次移植（re-OLT）是治疗肝移植不可逆失败的唯一有效方法。早期和晚期移植失败导致两种不同的临床情况，应分别进行讨论。本研究旨在比较我院初次移植后移植肝功能不良患者的早期和晚期再次肝移植情况，并总结我们在再次肝移植方面的临床经验。
回顾性分析我院2004年1月至2007年2月31例再次肝移植的临床资料，分为早期再次肝移植组14例和晚期再次肝移植组17例。
胆道并发症是早期再次肝移植（57.1%）和晚期再次肝移植（52.9%）的主要指征。其他常见指征为早期再次肝移植中的血管并发症和晚期再次肝移植中的原发病复发。两组在手术出血量、冷缺血时间、手术时长和围手术期死亡率方面无显著差异；除终末期肝病模型（MELD）评分外。早期再次肝移植组7例患者和晚期再次肝移植组9例患者死亡。早期再次肝移植组2例死于多器官功能衰竭，3例死于严重脓毒症相关疾病；晚期再次肝移植组4例死于严重脓毒症相关疾病，3例死于肝细胞癌（HCC）复发。早期再次肝移植患者再次肝移植后1年和2年的精算生存率分别为55.2%和36.9%，晚期再次肝移植患者分别为65.1%和52%。两组生存率无显著差异。
早期和晚期再次肝移植可取得相似的临床结果。合适的指征和最佳手术时机、充分的术前准备、经验丰富的手术操作以及有效的围手术期抗感染策略有助于提高再次肝移植患者的总体生存率。
