华沙医科大学普通、移植与肝脏外科进行的1000例肝移植——适应证与结果分析

1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw--analysis of indications and results.

作者信息

Krawczyk Marek, Grąt Michał, Barski Krzysztof, Ligocka Joanna, Antczak Arkadiusz, Kornasiewicz Oskar, Skalski Michał, Patkowski Waldemar, Nyckowski Paweł, Zieniewicz Krzysztof, Grzelak Ireneusz, Pawlak Jacek, Alsharabi Abdulsalam, Wróblewski Tadeusz, Paluszkiewicz Rafał, Najnigier Bogusław, Dudek Krzysztof, Remiszewski Piotr, Smoter Piotr, Grodzicki Mariusz, Korba Michał, Kotulski Marcin, Cieślak Bartosz, Kalinowski Piotr, Gierej Piotr, Frączek Mariusz, Rdzanek Łukasz, Stankiewicz Rafał, Kobryń Konrad, Nazarewski Łukasz, Leonowicz Dorota, Urban-Lechowicz Magdalena, Skwarek Anna, Giercuszkiewicz Dorota, Paczkowska Agata, Piwowarska Jolanta, Gelo Remigiusz, Andruszkiewicz Paweł, Brudkowska Anna, Andrzejewska Renata, Niewiński Grzegorz, Kilińska Beata, Zarzycka Aleksandra, Nowak Robert, Kosiński Cezary, Korta Teresa, Ołdakowska-Jedynak Urszula, Sańko-Resmer Joanna, Foroncewicz Bartosz, Ziółkowski Jacek, Mucha Krzysztof, Senatorski Grzegorz, Pączek Leszek, Habior Andrzej, Lechowicz Robert, Polański Sławomir, Leowska Elżbieta, Pacho Ryszard, Andrzejewska Małgorzata, Rowiński Olgierd, Kozieł Sławomir, Żurakowski Jerzy, Ziarkiewicz-Wróblewska Bogna, Górnicka Barbara, Hevelke Piotr, Michałowicz Bogdan, Karwowski Andrzej, Szczerbań Jerzy

机构信息

Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.

出版信息

Pol Przegl Chir. 2012 Jun;84(6):304-12. doi: 10.2478/v10035-012-0051-y.

DOI:10.2478/v10035-012-0051-y

PMID:22842743

Abstract

THE AIM OF THE STUDY

was to analyze indications and results of the first one thousand liver transplantations at Chair and Clinic of General, Transplantation and Liver Surgery, Medical University of Warsaw.

MATERIAL AND METHODS

Data from 1000 transplantations (944 patients) performed at Chair and Clinic of General, Transplantation and Liver Surgery between 1994 and 2011 were analyzed retrospectively. These included 943 first transplantations and 55 retransplantations and 2 re-retransplantations. Frequency of particular indications for first transplantation and retransplantations was established. Perioperative mortality was defined as death within 30 days after the transplantation. Kaplan-Meier survival analysis was used to estimate 5-year patient and graft survival.

RESULTS

The most common indications for first transplantation included: liver failure caused by hepatitis C infection (27.8%) and hepatitis B infection (18%) and alcoholic liver disease (17.7%). Early (< 6 months) and late (> 6 months) retransplantations were dominated by hepatic artery thrombosis (54.3%) and recurrence of the underlying disease (45%). Perioperative mortality rate was 8.9% for first transplantations and 34.5% for retransplantations. Five-year patient and graft survival rate was 74.3% and 71%, respectively, after first transplantations and 54.7% and 52.9%, respectively, after retransplantations.

CONCLUSIONS

Development of liver transplantation program provided more than 1000 transplantations and excellent long-term results. Liver failure caused by hepatitis C and B infections remains the most common cause of liver transplantation and structure of other indications is consistent with European data.

摘要

研究目的

分析华沙医科大学普通、移植与肝脏外科教研室及临床科室进行的前1000例肝移植的适应证及结果。

材料与方法

回顾性分析1994年至2011年在普通、移植与肝脏外科教研室及临床科室进行的1000例移植手术（944例患者）的数据。其中包括943例首次移植、55例再次移植和2例二次再次移植。确定首次移植和再次移植的特定适应证频率。围手术期死亡率定义为移植后30天内死亡。采用Kaplan-Meier生存分析评估5年患者及移植物生存率。

结果

首次移植最常见的适应证包括：丙型肝炎感染导致的肝衰竭（27.8%）、乙型肝炎感染（18%）和酒精性肝病（17.7%）。早期（<6个月）和晚期（>6个月）再次移植主要由肝动脉血栓形成（54.3%）和基础疾病复发（45%）所致。首次移植围手术期死亡率为8.9%，再次移植为34.5%。首次移植后5年患者及移植物生存率分别为74.3%和71%，再次移植后分别为54.7%和52.9%。