Fu Bin-sheng, Zhang Tong, Li Hua, Yi Shu-hong, Wang Gen-shu, Zhang Jian, Xu Chi, Yang Yang, Cai Chang-jie, Lu Min-qiang, Chen Gui-hua
Liver Transplant Center, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
Zhonghua Wai Ke Za Zhi. 2011 Nov;49(11):1007-10.
To compare early and late orthotopic liver retransplantation (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 36 re-OLTs from January 2004 to July 2009 were analyzed retrospectively, consisting of the first group with 17 cases of early re-OLT and the second group with 19 cases of late re-OLT. The average ages were (45 ± 13) years and (48 ± 10) years, and the time intervals were (49 ± 54) days and (514 ± 342) days in early re-OLT group and late re-OLT group, respectively.
Biliary tract complications were the main indications for early re-OLT and late re-OLT. 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 the MELD score. Outcome was fatal for 8 patients in early re-OLT and 10 patients in late re-OLT. Three deaths were due to severe sepsis-related disease, 3 deaths due to multiple organ failure in early re-OLT and 4 deaths due to severe sepsis-related disease, 3 deaths due to recurrence of HCC in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 52.9% and 41.2%, respectively, for patients in early re-OLT, and 63.2% and 52.6%, respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups (P > 0.05).
The similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, experienced surgical procedures and effective perioperative anti-infection strategy contribute to the improvement of the overall survival rate of the patients after re-OLT.
比较我院原发性肝移植术后移植物功能不良患者的早期和晚期原位肝再次移植（再次肝移植）情况，并总结再次肝移植的临床经验。
回顾性分析2004年1月至2009年7月间36例再次肝移植患者的临床资料，分为早期再次肝移植组17例和晚期再次肝移植组19例。早期再次肝移植组和晚期再次肝移植组的平均年龄分别为（45±13）岁和（48±10）岁，时间间隔分别为（49±54）天和（514±342）天。
胆道并发症是早期和晚期再次肝移植的主要指征。其他常见指征在早期再次肝移植中为血管并发症，在晚期再次肝移植中为原发性疾病复发。除终末期肝病模型（MELD）评分外，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未发现显著差异。早期再次肝移植组有8例患者死亡，晚期再次肝移植组有10例患者死亡。早期再次肝移植组3例死亡归因于严重脓毒症相关疾病，3例死于多器官功能衰竭；晚期再次肝移植组4例死亡归因于严重脓毒症相关疾病，3例死于肝癌复发。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52.9%和41.2%，晚期再次肝移植患者分别为63.2%和52.6%。两组生存率差异无统计学意义（P>0.05）。
早期和晚期再次肝移植可获得相似的临床结果。合适的指征和最佳手术时机、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。
