Stankiewicz R, Kornasiewicz O, Grąt M, Lewandowski Z, Gorski Z, Krawczyk M
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2017 Jul-Aug;49(6):1364-1368. doi: 10.1016/j.transproceed.2017.01.083.
Orthotopic liver retransplantation (reLT) is considered to have poorer outcomes than primary transplantation. The objective of this study was to analyze the impact of medical urgency status as a predictor of patient survival after reLT.
Forty-nine patients who underwent reLT were included in this retrospective study. Urgent or elective status was based on the judgment of the surgical team, selected variables, and the Model for End-Stage Liver Disease score. Multivariate analysis was performed to identify variables associated with patient survival following reLT.
Overall survival of the patient cohort was 57% at 1 year and 54.3% at 3 years after reTL. Survival in urgent-status patients was 68.8% and 63.4% at 1 and 3 years, respectively, whereas the survival rate for elective patients was 40.0% at both time points. Mortality was significantly associated with elective status (hazard ratio [HR], 2.42; P = .046) at 1 year, but was no longer significant (HR, 2.19; P < .069) after 3 years of follow-up.
Elective status is associated with poorer outcome. Patient selection determines long-term survival more than any other single factor, so for patients designated to an elective status, prompt retransplantation should be encouraged.
原位肝再次移植（reLT）被认为比初次移植的预后更差。本研究的目的是分析作为reLT后患者生存预测指标的医疗紧急状态的影响。
本回顾性研究纳入了49例行reLT的患者。紧急或择期状态基于手术团队的判断、选定变量以及终末期肝病模型评分。进行多变量分析以确定与reLT后患者生存相关的变量。
患者队列在reTL后1年的总生存率为57%，3年时为54.3%。紧急状态患者在1年和3年时的生存率分别为68.8%和63.4%，而择期患者在两个时间点的生存率均为40.0%。1年时死亡率与择期状态显著相关（风险比[HR]，2.42；P = 0.046），但在随访3年后不再显著（HR，2.19；P < 0.069）。
择期状态与较差的预后相关。患者选择比任何其他单一因素更能决定长期生存，因此对于被指定为择期状态的患者，应鼓励及时进行再次移植。
