Trunecka Pavel, Adamec Milos, Spicák Julius, Honsová Eva, Kieslichová Eva, Lánská Vera, Peregrin Jan, Kucera Milos, Janousek Libor, Oliverius Martin, Drastich Pavel, Rocen Milan, Danc Roman, Gottfriedová Halima, Franková Sona, Sperl Jan, Pokorná Eva, Vítko Stefan, Malý Jan
Institut klinické a experimentální medicíny Praha, Transplantcentrum.
Cas Lek Cesk. 2011;150(1):60-7.
Between April 1995 and November 2005, 500 liver transplantations were performed in 476 patients of age from 3, till 70, at the Transplantation center of the Institute of Clinical and Experimental Medicine (IKEM) in Prague. The most common indications for liver transplantation were alcoholic liver cirrhosis (23%), hepatitis C cirrhosis (17%), and cholestatic cirrhosis (PBC and PSC, 9% each). Mean MELD score of recipients at the transplantation was 15-18 for each year of transplantation. Ten-years patient survival was 79.1 +/- 2.2%, and graft survival 74.1 +/- 2.1% respectively. Best patient and graft survival was achieved among patients transplanted for autoimmune liver diseases, the worst in group of patients with alcoholic cirrhosis. Malignancies were the most common cause of death during the period of follow-up (17 patients).
Patients were followed longitudinally at the Department of hepatogastroenterology IKEM according to prospective protocol included protocol biopsies. Hypertension (in 71% of recipients), and overweight or obesity (in 56.3%), were the most prevalent medical complications among long-term survivors. Diabetes was found in 28.6%, of which 14.7% was de-nove diabetes after transplantation. Renal insufficiency (S-creatinin > 150 micromol/l) was present in 61 of 348 (17.6%) survivors. Out of these, 16 needed chronic hemodialysis, and 12 underwent kidney transplantation subsequently. Protocol biopsy at 5 years after transplantation was evaluated in a sample of 102 unselected liver transplant recipients. Normal liver was found in 4% of recipients, minor non-specific changes in 36% of them. Disease recurrence was present in all of 16 recipients transplanted for HCV cirrhosis, in one third of them graft cirrhosis was already present. Disease recurrence was found in patients transplanted for autoimmune disease frequently, PBC in 40%, PSC in 25%, and autoimmune hepatitis in 60% of recipients. Graft steatosis greater than 33% was present in 13% of recipients.
Liver transplantation is highly effective method of treatment of end stage liver disease. Despite frequent medical complications, and disease recurrence on histological examination almost 80% of recipients transplanted in the liver transplantation program in IKEM survived more than 10 years after procedure. The survival achieved was far above that of the European liver transplant registry.
1995年4月至2005年11月期间，布拉格临床与实验医学研究所（IKEM）移植中心对476例年龄在3岁至70岁之间的患者进行了500例肝移植手术。肝移植最常见的适应证是酒精性肝硬化（23%）、丙型肝炎肝硬化（17%）和胆汁淤积性肝硬化（原发性胆汁性肝硬化和原发性硬化性胆管炎，各占9%）。每年移植时受者的平均终末期肝病模型（MELD）评分均为15 - 18分。患者10年生存率为79.1±2.2%，移植物生存率为74.1±2.1%。自身免疫性肝病患者的患者和移植物生存率最佳，酒精性肝硬化患者组最差。恶性肿瘤是随访期间最常见的死亡原因（17例患者）。
根据前瞻性方案，包括方案活检，IKEM胃肠肝病科对患者进行纵向随访。高血压（71%的受者）和超重或肥胖（56.3%）是长期存活者中最常见的医学并发症。28.6%的患者发现患有糖尿病，其中14.7%是移植后新发糖尿病。348例（17.6%）存活者中有61例存在肾功能不全（血清肌酐>150μmol/L）。其中，16例需要长期血液透析，12例随后接受了肾移植。对102例未经选择的肝移植受者样本进行了移植后5年的方案活检评估。4%的受者肝脏正常，36%的受者有轻微非特异性改变。16例因丙型肝炎肝硬化接受移植的受者均出现疾病复发，其中三分之一已出现移植物肝硬化。自身免疫性疾病患者移植后也经常出现疾病复发，原发性胆汁性肝硬化患者中40%复发，原发性硬化性胆管炎患者中25%复发，自身免疫性肝炎患者中60%复发。13%的受者出现大于33%的移植物脂肪变性。
肝移植是治疗终末期肝病的高效方法。尽管存在频繁的医学并发症以及组织学检查发现疾病复发，但IKEM肝移植项目中近80%的受者在手术后存活超过10年。所取得的生存率远高于欧洲肝移植登记处的生存率。
