Rajoriya Neil, Tripathi Dhiraj, Leithead Joanna A, Gunson Bridget K, Lord Sophie, Ferguson James W, Hirschfield Gideon M
Neil Rajoriya, Dhiraj Tripathi, Joanna A Leithead, Bridget K Gunson, Sophie Lord, James W Ferguson, Gideon M Hirschfield, Liver Unit, Queen Elizabeth Hospital, Birmingham B152WB, United Kingdom.
World J Gastroenterol. 2016 Dec 7;22(45):9966-9973. doi: 10.3748/wjg.v22.i45.9966.
To establish the impact of portal hypertension (PH) on wait-list/post-transplant outcomes in patients with polycystic liver disease (PCLD) listed for liver transplantation.
A retrospective single-centre case controlled study of consecutive patients listed for liver transplantation over 12 years was performed from our centre. PH in the PCLD cohort was defined by the one or more of following parameters: (1) presence of radiological or endoscopic documented varices from our own centre or the referral centre; (2) splenomegaly (> 11 cm) on radiology in absence of splenic cysts accounting for increased imaging size; (3) thrombocytopenia (platelets < 150 × 10/L); or (4) ascites without radiological evidence of hepatic venous outflow obstruction from a single cyst.
Forty-seven PCLD patients (F: M = 42: 5) were listed for liver transplantation (LT) (single organ, = 35; combined liver-kidney transplantation, = 12) with 19 patients (40.4%) having PH. When comparing the PH group with non-PH group, the mean listing age (PH group, 50.6 (6.4); non-PH group, 47.1 (7.4) years; = 0.101), median listing MELD (PH group, 12; non-PH group, 11; = 0.422) median listing UKELD score (PH group, 48; non-PH group, 46; = 0.344) and need for renal replacement therapy ( = 0.317) were similar. In the patients who underwent LT alone, there was no difference in the duration of ICU stay (PH, 3 d; non-PH, 2 d; = 0.188), hospital stay length (PH, 9 d; non-PH, 10 d; = 0.973), or frequency of renal replacement therapy (PH, 2/8; non-PH, 1/14; = 0.121) in the immediate post-transplantation period.
Clinically apparent portal hypertension in patients with PCLD listed for liver transplantation does not appear to have a major impact on wait-list or peri-transplant morbidity.
确定门静脉高压（PH）对列入肝移植名单的多囊肝病（PCLD）患者等待名单/移植后结局的影响。
对我们中心12年来连续列入肝移植名单的患者进行回顾性单中心病例对照研究。PCLD队列中的PH由以下一个或多个参数定义：（1）我们自己中心或转诊中心影像学或内镜检查记录有静脉曲张；（2）影像学显示脾肿大（>11 cm），且无脾囊肿导致影像增大；（3）血小板减少（血小板<150×10/L）；或（4）腹水，且无单一囊肿导致肝静脉流出道梗阻的影像学证据。
47例PCLD患者（女：男 = 42：5）被列入肝移植名单（单器官移植，n = 35；肝肾联合移植，n = 12），其中19例（40.4%）有PH。将PH组与非PH组进行比较，平均列入名单年龄（PH组，50.6（6.4）岁；非PH组，47.1（7.4）岁；P = 0.101）、列入名单时的中位终末期肝病模型（MELD）评分（PH组，12；非PH组，11；P = 0.422）、列入名单时的中位英国终末期肝病评分（UKELD）（PH组，48；非PH组，46；P = 0.344）以及肾脏替代治疗需求（P = 0.317）相似。在仅接受肝移植的患者中，移植后即刻重症监护病房（ICU）住院时间（PH组，3天；非PH组，2天；P = 0.188）、住院时间（PH组，9天；非PH组，10天；P = 0.973）或肾脏替代治疗频率（PH组，2/8；非PH组，1/14；P = 0.121）无差异。
列入肝移植名单的PCLD患者临床上明显的门静脉高压似乎对等待名单或移植周围期发病率没有重大影响。
