Li Min-Ru, Huang Zheng-Yu, Cai Chang-Jie, Yi Hui-Min, An Yu-Ling, Chen Gui-Hua
Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guang dong, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2010 Jan;22(1):12-5.
To observe the effect of artificial liver support system (ALSS) after liver transplantation on the survival rate of severe hepatitis patients.
Patients with severe hepatitis with model for end stage liver disease (MELD) score above 35 were divided into two groups according to whether pre-transplantation ALSS was instituted (n=23) or not (n=41). Evaluation was performed on the day when the patient entered into the waiting list and 1 day pre-transplantation. Survival rates and survival curves were estimated with Kaplan-Meier method. Log-Rank test for trends was used when comparing curves.
There was no significant difference between two groups when comparing the parameters including prothrombin time, fibrinogen, total bilirubin, blood ammonia, creatinine, MELD score on the day of entering into the waiting list (all P>0.05). After the therapy of ALSS, the parameters of ALSS group were significantly improved comparing to those of the control group (all P<0.01). MELD score of ALSS group on the day pre-transplant was decreased significantly comparing to that on the day entering into the waiting list (37.6+/-2.0 vs. 41.4+/-2.2, P<0.01), with the difference in MELD score (DeltaMELD) of -3.8. MELD score of control group on the day entering into the waiting list and 1 day pre-transplant was 40.6+/-1.7 and 41.0+/-1.6 respectively, with DeltaMELD of +0.4 ( P>0.05). The blood loss and operation time in ALSS group was significantly less than the control group [(4 070.0+/-688.1) ml vs. (4 905.9+/-1 142.1) ml, (9.4+/-1.1) hours vs. (10.5+/-1.0) hours, P<0.05 and P<0.01). Thirty days and 1 year survival rate of ALSS group was 91% and 82%, and that of control group was 76% and 59% respectively (P=0.044).
ALSS can improve the survival rate of patients with severe hepatitis undergoing liver transplantation through ameliorating physiological status, lessening blood loss during operation and operation time.
观察肝移植术后人工肝支持系统（ALSS）对重型肝炎患者生存率的影响。
将终末期肝病模型（MELD）评分高于35分的重型肝炎患者，根据术前是否进行ALSS治疗分为两组（n = 23）和未进行ALSS治疗组（n = 41）。在患者进入等待名单当天及移植前1天进行评估。采用Kaplan-Meier法估计生存率和生存曲线。比较曲线时使用Log-Rank趋势检验。
在比较包括凝血酶原时间、纤维蛋白原、总胆红素、血氨、肌酐、进入等待名单当天的MELD评分等参数时，两组之间无显著差异（均P>0.05）。经过ALSS治疗后，ALSS组的参数与对照组相比有显著改善（均P<0.01）。ALSS组移植前1天的MELD评分与进入等待名单当天相比显著降低（37.6±2.0 vs. 41.4±2.2，P<0.01），MELD评分差值（ΔMELD）为-3.8。对照组进入等待名单当天和移植前1天的MELD评分分别为40.6±1.7和41.0±1.6，ΔMELD为+0.4（P>0.05）。ALSS组的失血量和手术时间显著少于对照组[（4070.0±688.1）ml vs.（4905.9±1142.1）ml，（9.4±1.1）小时vs.（10.5±1.0）小时，P<0.05和P<0.01]。ALSS组30天和1年生存率分别为91%和82%，对照组分别为76%和59%（P = 0.044）。
ALSS可通过改善生理状态、减少手术中的失血量和手术时间，提高重型肝炎患者肝移植后的生存率。
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