Zahr Eldeen Firas, Mabrouk Mourad Moustafa, Liossis Christos, Bramhall Simon R
Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Exp Clin Transplant. 2014 Jun;12(3):175-83.
Liver retransplant is the only treatment for patients with irreversible graft failure. However, given the severe shortage of organs, there is an ethical question of equity in the distribution of this resource. Liver retransplant is more expensive and is associated with lower patient/graft survival rates than equivalent rates after primary transplant. Both primary nonfunction and hepatic artery thrombosis account for nearly all cases of early liver retransplant. Late indications of liver retransplant include chronic rejection, biliary complications, or recurrence of primary disease such as hepatitis C, autoimmune hepatitis, and primary sclerosing cholangitis. Donor data are not available when a patient is listed for liver retransplant; therefore, prognostic factors related to the recipient is a more practical way of making the decision to offer liver retransplant is made. In the Model of End-stage Liver Disease era liver retransplant for "late" indications is more complex and selection criteria are more stringent. We review the literature for predictive factors influencing outcome of liver retransplant, especially in those with recurrent disease.
肝脏再次移植是不可逆移植物衰竭患者的唯一治疗方法。然而，鉴于器官严重短缺，这种资源分配存在公平性的伦理问题。肝脏再次移植比初次移植费用更高，且患者/移植物存活率更低。原发性无功能和肝动脉血栓形成几乎占了所有早期肝脏再次移植的病例。肝脏再次移植的晚期指征包括慢性排斥反应、胆道并发症或丙型肝炎、自身免疫性肝炎和原发性硬化性胆管炎等原发性疾病的复发。当患者被列入肝脏再次移植名单时，供体数据不可用；因此，与受者相关的预后因素是做出肝脏再次移植决定的更实际方法。在终末期肝病模型时代，“晚期”指征的肝脏再次移植更为复杂，选择标准也更为严格。我们回顾了影响肝脏再次移植结果的预测因素的文献，特别是那些患有复发性疾病的患者。
