Sanabria Mateos Rebeca, Hogan Niamh M, Dorcaratto Dimitri, Heneghan Helen, Udupa Venkatesh, Maguire Donal, Geoghegan Justin, Hoti Emir
Rebeca Sanabria Mateos, Niamh M Hogan, Dimitri Dorcaratto, Helen Heneghan, Venkatesh Udupa, Donal Maguire, Justin Geoghegan, Emir Hoti, Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Dublin 4, Ireland.
World J Hepatol. 2016 Feb 8;8(4):226-30. doi: 10.4254/wjh.v8.i4.226.
To evaluate the outcomes of two-stage liver transplant at a single institution, between 1993 and March 2015.
We reviewed our institutional experience with emergency hepatectomy followed by transplantation for fulminant liver failure over a twenty-year period. A retrospective review of a prospectively maintained liver transplant database was undertaken at a national liver transplant centre. Demographic data, clinical presentation, preoperative investigations, cardiocirculatory parameters, operative and postoperative data were recorded.
In the study period, six two-stage liver transplants were undertaken. Indications for transplantation included acute paracetamol poisoning (n = 3), fulminant hepatitis A (n = 1), trauma (n = 1) and exertional heat stroke (n = 1). Anhepatic time ranged from 330 to 2640 min. All patients demonstrated systemic inflammatory response syndrome in the first post-operative week and the incidence of sepsis was high at 50%. There was one mortality, secondary to cardiac arrest 12 h following re-perfusion. Two patients required re-transplantation secondary to arterial thrombosis. At a median follow-up of 112 mo, 5 of 6 patients are alive and without evidence of graft dysfunciton.
Two-stage liver transplantation represents a safe and potentially life-saving treatment for carefully selected exceptional cases of fulminant hepatic failure.
评估1993年至2015年3月间在单一机构进行的两阶段肝移植的结果。
我们回顾了本机构在20年期间对暴发性肝衰竭患者先进行急诊肝切除然后进行移植的经验。在一个国家肝移植中心对前瞻性维护的肝移植数据库进行了回顾性研究。记录了人口统计学数据、临床表现、术前检查、心脏循环参数、手术及术后数据。
在研究期间，共进行了6例两阶段肝移植。移植指征包括急性扑热息痛中毒（3例）、暴发性甲型肝炎（1例）、创伤（1例）和劳力性热射病（1例）。无肝期从330分钟到2640分钟不等。所有患者在术后第一周均出现全身炎症反应综合征，败血症发生率高达50%。有1例患者在再灌注后12小时因心脏骤停死亡。2例患者因动脉血栓形成需要再次移植。中位随访112个月时，6例患者中有5例存活，且无移植物功能障碍的迹象。
对于精心挑选的暴发性肝衰竭特殊病例，两阶段肝移植是一种安全且可能挽救生命的治疗方法。
