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冰岛的肝移植:适应症和结果的回顾性研究

[Liver transplantation in Iceland: a retrospective study of indications and results].

作者信息

Eggertsdóttir Claessen Lára Ósk, Björnsson Einar Stefán, Bergmann Óttar Már, Ólafsson Sigurður

出版信息

Laeknabladid. 2016 Jan;102(1):19-24. doi: 10.17992/lbl.2016.01.60.

Abstract

BACKGROUND/AIMS: Liver transplantation is an important treatment option for end-stage liver disease. Since liver transplantation is not performed in Iceland, patients are sent abroad for this procedure. The aim of this study was to investigate indications and results of liver transplantations for Icelandic patients.

MATERIALS AND METHODS

The study was retrospective and included all patients in Iceland who had undergone liver transplantation from the first transplantation in 1984 to the end of 2012. Information was gathered from medical records. The study period was divided into three subperiods in order to evaluate changes in frequency of transplantation and survival.

RESULTS

During the period, 45 liver transplantations, thereof five retransplantations, were performed. Of 40 patients 16 were males, 18 females, mean age 40 years. There were six children, 2 girls and 4 boys with an age range of 0.4-12 years. Number of transplantation per million inhabitants increased significantly (2.40 during 1984-1996; 5.18 during 1997-2006 and 8.90 during 2007-2013; p<0.01). The main indication for transplantation was cirrhosis with complications in 26 patients (65%), acute liver failure in 6 (15%), cirrhosis and hepatocellular carcinoma in three (8%), and hemangioendothelioma in two (5%). The most common underlying liver diseases were primary biliary cirrhosis in 8 (20%), autoimmune hepatitis in four (10%), alcoholic cirrhosis in three (7.5%) and primary sclerosing cholangitis in three (7.5%). The mean waiting time for transplantation was 5.9 months (median 3.2). Survial was 84% in one year and 63% in 5 years. Survival increased during the study period.

CONCLUSIONS

The number of liver transplantations has increased significantly in recent years. Survival has improved and is comparable to survival in countries where liver transplantations are performed.

摘要

背景/目的:肝移植是终末期肝病的重要治疗选择。由于冰岛不开展肝移植手术,患者需前往国外进行该手术。本研究旨在调查冰岛患者肝移植的适应证及结果。

材料与方法

本研究为回顾性研究,纳入了1984年首例肝移植至2012年末在冰岛接受肝移植的所有患者。信息收集自病历。研究期分为三个子时期,以评估移植频率和生存率的变化。

结果

在此期间,共进行了45例肝移植手术,其中5例为再次移植。40例患者中,男性16例,女性18例,平均年龄40岁。有6名儿童,2名女孩和4名男孩,年龄范围为0.4 - 12岁。每百万居民的移植数量显著增加(1984 - 1996年为2.40;1997 - 2006年为5.18;2007 - 2013年为8.90;p<0.01)。移植的主要适应证为肝硬化伴并发症26例(65%),急性肝衰竭6例(15%),肝硬化合并肝细胞癌3例(8%),血管内皮瘤2例(5%)。最常见的潜在肝脏疾病为原发性胆汁性肝硬化8例(20%),自身免疫性肝炎4例(10%),酒精性肝硬化3例(7.5%),原发性硬化性胆管炎3例(7.5%)。移植的平均等待时间为5.9个月(中位数3.2个月)。1年生存率为84%,5年生存率为63%。研究期间生存率有所提高。

结论

近年来肝移植数量显著增加。生存率有所改善,与开展肝移植手术国家的生存率相当。

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