Rana Abbas, Petrowsky Henrik, Kaplan Bruce, Jie Tun, Porubsky Marian, Habib Shahid, Rilo Horacio, Gruessner Angelika C, Gruessner Rainer W G
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ, USA.
Transpl Int. 2014 Feb;27(2):141-51. doi: 10.1111/tri.12201. Epub 2013 Oct 18.
Up to 23% of liver allografts fail post-transplant. Retransplantation is only the recourse but remains controversial due to inferior outcomes. The objective of our study was to identify high-risk periods for retransplantation and then compare survival outcomes and risk factors. We performed an analysis of United Network for Organ Sharing (UNOS) data for all adult liver recipients from 2002 through 2011. We analyzed the records of 49,288 recipients; of those, 2714 (5.5%) recipients were retransplanted. Our analysis included multivariate regression with the outcome of retransplantation. The highest retransplantation rates were within the first week (19% of all retransplantation, day 0-7), month (20%, day 8-30), and year (33%, day 31-365). Only retransplantation within the first year (day 0-365) had below standard outcomes. The most significant risk factors were as follows: within the first week, cold ischemia time >16 h [odds ratio (OR) 3.6]; within the first month, use of split allografts (OR 2.9); and within the first year, use of a liver donated after cardiac death (OR 4.9). Each of the three high-risk periods within the first year had distinct causes of graft failure, risk factors for retransplantation, and survival rates after retransplantation.
高达23%的肝脏同种异体移植在移植后失败。再次移植是唯一的补救措施，但由于效果较差，仍然存在争议。我们研究的目的是确定再次移植的高风险期，然后比较生存结果和风险因素。我们对器官共享联合网络（UNOS）2002年至2011年所有成年肝脏接受者的数据进行了分析。我们分析了49288名接受者的记录；其中，2714名（5.5%）接受者接受了再次移植。我们的分析包括以再次移植结果为变量的多因素回归分析。再次移植率最高的时期是在第一周（占所有再次移植的19%，第0 - 7天）、第一个月（20%，第8 - 30天）和第一年（33%，第31 - 365天）。只有第一年（第0 - 365天）内的再次移植结果低于标准。最显著的风险因素如下：在第一周内，冷缺血时间>16小时[比值比（OR）3.6]；在第一个月内，使用劈裂式同种异体移植物（OR 2.9）；在第一年内，使用心脏死亡后捐赠的肝脏（OR 4.9）。第一年的三个高风险期各自具有不同的移植物失败原因、再次移植的风险因素以及再次移植后的生存率。
