Sintra S N, Tomé L, Cipriano M A, Bento C, Furtado E
University Hospital of Coimbra, Coimbra, Portugal.
Transplant Proc. 2013 Apr;45(3):1119-21. doi: 10.1016/j.transproceed.2013.02.101.
Liver transplantation modifies the natural history of end-stage liver diseases and stabilizes the course of familial amyloidotic polyneuropathy. An evaluation of its long-term results allows insight and awareness of factors that impact survival.
We included 150 consecutive patients who underwent liver transplantation between October 1992 and January 1998. The impact of disease, cold ischemic time, ABO compatibility, acute and chronic rejection episodes, and vascular, biliary and infectious complications on survival were compared.
We included 65 patients (43.3%) with familial amyloidotic polyneuropathy, 41 (27.3%) with cirrhosis, 12 (8%) with hepatocellular carcinoma, and 11 (7.3%) with acute hepatic failure. The mean age was 39 years. The mean cold ischemic time was 493 ± 161 minutes. There were 115 (77.2%) ABO-identical transplants; 25 (16.8%) were ABO compatible, and 9 (6%) were ABO incompatible. Acute cellular rejection occurred in 88 recipients (58.7%); chronic rejection was diagnosed in 9 (6%). Complications included vascular (16.7% patients; n = 25) and biliary (38.7%; n = 58). Infections were bacterial in 92 (61.3%), fungal in 35 (23.3%), and cytomegalovirus in 9 (6%). The survival rates were 78% at 1 year, 68.7% at 5 years, and 58% at 10 years. Of the 150 patients, 82 survived until November 2011. Follow-up ranged from 13 to 19 years. In this study, only bacterial infections had a negative influence on patients' survival (P = .014).
The high frequency of biliary and vascular complications was associated with increased morbidity but not mortality. Bacterial infections were related to an ominous outcome, being responsible for short- and long-term mortality.
肝移植改变了终末期肝病的自然病程，并稳定了家族性淀粉样多神经病的病程。对其长期结果进行评估有助于深入了解影响生存的因素。
我们纳入了1992年10月至1998年1月期间连续接受肝移植的150例患者。比较了疾病、冷缺血时间、ABO血型相容性、急性和慢性排斥反应发作以及血管、胆道和感染性并发症对生存的影响。
我们纳入了65例（43.3%）家族性淀粉样多神经病患者、41例（27.3%）肝硬化患者、12例（8%）肝细胞癌患者和11例（7.3%）急性肝衰竭患者。平均年龄为39岁。平均冷缺血时间为493±161分钟。有115例（77.2%）ABO血型相同的移植；25例（16.8%）为ABO血型相容，9例（6%）为ABO血型不相容。88例受者（58.7%）发生急性细胞排斥反应；9例（6%）被诊断为慢性排斥反应。并发症包括血管并发症（16.7%的患者；n = 25）和胆道并发症（38.7%；n = 58）。感染中细菌感染92例（61.3%）、真菌感染35例（23.3%）、巨细胞病毒感染9例（6%）。1年生存率为78%，5年生存率为68.7%，10年生存率为58%。150例患者中，82例存活至2011年11月。随访时间为13至19年。在本研究中，只有细菌感染对患者生存有负面影响（P = 0.014）。
胆道和血管并发症的高发生率与发病率增加相关，但与死亡率无关。细菌感染与不良预后相关，是短期和长期死亡的原因。
