Gómez Cabeza de Vaca V, Bernal Bellido C, Alamo Martínez J N, Suárez Artacho G, Marín Gómez L M, Serrano Díaz-Canedo J, Padillo Ruiz F J, Gómez Bravo M A
General and Gastrointestinal Surgery Department, Hospital Universitario Virgen del Rocío, Seville, Spain.
Transplant Proc. 2012 Sep;44(7):2076-7. doi: 10.1016/j.transproceed.2012.07.069.
To analyze the epidemiology, causes, complications, and mortality of liver transplants following fulminant hepatic failure over the last 16 years.
We completed a descriptive analysis of 21 patients with fulminant hepatic failure and a liver transplant. In almost half of the cases, the origin of liver failure was unknown.
The mean age was 36 years; the study group was 47.61% female (n = 10) and 52.39% male (n = 11). The most common early complication was transplant rejection, which occurred in 33.3% of all patients (n = 7) and was confirmed by liver biopsy; the most frequent long-term complication was autoimmune hepatitis. Two retransplantations were necessary. The total mortality rate was 38.1% (n = 8) with late mortality in three patients (14.3%).
Orthotopic liver transplantation as a treatment for fulminant hepatitis has a higher mortality rate than orthotopic liver transplantation due to other causes. It does, however, enable the survival of 62% of the patients who otherwise would have died due to liver failure. The etiology of most of the cases was unknown. We should point out the high incidence rates for transplant rejection and late autoimmune hepatitis, in addition to the possibility of hemorrhagic colonic diseases that may be associated with the condition causing liver failure. Multidisciplinary control over the patient is useful for deciding at which time a liver transplant would become the only treatment option.
分析过去16年暴发性肝衰竭后肝移植的流行病学、病因、并发症及死亡率。
我们对21例暴发性肝衰竭并接受肝移植的患者进行了描述性分析。几乎一半的病例中，肝衰竭的病因不明。
平均年龄为36岁；研究组中女性占47.61%（n = 10），男性占52.39%（n = 11）。最常见的早期并发症是移植排斥反应，发生在所有患者的33.3%（n = 7）中，经肝活检确诊；最常见的长期并发症是自身免疫性肝炎。需要进行两次再次移植。总死亡率为38.1%（n = 8），3例患者出现晚期死亡（14.3%）。
作为暴发性肝炎治疗方法的原位肝移植的死亡率高于其他病因导致的原位肝移植。然而，它确实使62%的原本会因肝衰竭死亡的患者存活下来。大多数病例的病因不明。我们应指出移植排斥反应和晚期自身免疫性肝炎的高发病率，以及可能与导致肝衰竭的疾病相关的出血性结肠疾病的可能性。对患者进行多学科管理有助于确定何时肝移植将成为唯一的治疗选择。
