经颈静脉肝内门体分流术应用于等待肝移植名单上的患者，并非原位肝移植预后的禁忌证。

Transjugular intrahepatic portosystemic shunt for a wait list patient is not a contraindication for orthotopic liver transplant outcomes.

作者信息

Levi Sandri Giovanni Battista, Lai Quirino, Lucatelli Pierleone, Melandro Fabio, Guglielmo Nicola, Mennini Gianluca, Berloco Pasquale B, Fanelli Fabrizio, Salvatori Filippo Maria, Rossi Massimo

机构信息

Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Italy.

出版信息

Exp Clin Transplant. 2013 Oct;11(5):426-8. doi: 10.6002/ect.2013.0013. Epub 2013 Jun 6.

DOI:10.6002/ect.2013.0013

PMID:23745783

Abstract

OBJECTIVES

A transjugular intrahepatic portosystemic shunt for treating recurrent variceal bleeding or refractory ascites can be used as bridge therapy in patients awaiting a liver transplant. However, incorrect placement of the transjugular intrahepatic portosystemic shunt may complicate surgery during a liver transplant. This study sought to analyze a cohort of transplanted recipients to underscore whether transjugular intrahepatic portosystemic shunts can negatively affect liver transplant outcomes.

MATERIALS AND METHODS

We retrospectively analyzed 207 patients who had undergone a liver transplant between January 2001 and December 2009 in the Rome "La Sapienza" center. Transjugular intrahepatic portosystemic shunt was performed before the liver transplant in 36 cases (17%). The analyzed population was stratified into 2 groups (no transjugular intrahepatic portosystemic shunt [n=171 ] and transjugular intrahepatic portosystemic shunt [n=36 ]), and patient survival outcomes were compared.

RESULTS

In the no-transjugular intrahepatic portosystemic shunt group, 60 of 171 deaths (35%) were reported, 20 of which were seen in the first 3 months after the liver transplant. In the same group, 61 graft losses (36%) were observed, with 19 of which were seen in the first 3 months after the liver transplant. In transjugular intrahepatic portosystemic shunt group, 12 of the 36 deaths (33%) were seen; 5 patients died within 3 months of the liver transplant. In this latter group, 12 grafts (33%) were lost, 4 of which were reported during the first 3 months after surgery. The median patient survival was 64 months and 69 months in the 2 groups. On survival analysis, no significant differences were found between the 2 groups.

CONCLUSIONS

Transjugular intrahepatic portosystemic shunt does not seem to affect outcomes after a liver transplant. We suggest that clinicians recognized the location of the stent to prevent any difficulty during surgery.

摘要

目的

经颈静脉肝内门体分流术用于治疗复发性静脉曲张出血或难治性腹水，可作为等待肝移植患者的桥接治疗。然而，经颈静脉肝内门体分流术放置不当可能会使肝移植手术复杂化。本研究旨在分析一组移植受者，以强调经颈静脉肝内门体分流术是否会对肝移植结局产生负面影响。

材料与方法

我们回顾性分析了2001年1月至2009年12月在罗马“La Sapienza”中心接受肝移植的207例患者。36例（17%）患者在肝移植前进行了经颈静脉肝内门体分流术。将分析的人群分为2组（未行经颈静脉肝内门体分流术[n = 171]和经颈静脉肝内门体分流术[n = 36]），并比较患者的生存结局。

结果

在未行经颈静脉肝内门体分流术组，171例中有60例死亡（35%），其中20例发生在肝移植后的前3个月。在同一组中，观察到61例移植物丢失（36%），其中19例发生在肝移植后的前3个月。在经颈静脉肝内门体分流术组，36例中有12例死亡（33%）；5例患者在肝移植后3个月内死亡。在后一组中，12例移植物（33%）丢失，其中4例在术后前3个月报告。两组患者的中位生存时间分别为64个月和69个月。生存分析显示，两组之间无显著差异。