Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
Hepatol Int. 2017 Nov;11(6):517-522. doi: 10.1007/s12072-017-9821-2. Epub 2017 Sep 21.
There is a big controversy over liver retransplantation, the only life-saving treatment for patients with a failing or failed liver graft. This retrospective study tried to determine if living-donor liver retransplantation (re-LDLT) is a justifiable alternative to deceased-donor liver retransplantation (re-DDLT).
Anonymous data of liver transplant patients from January 2000 to April 2016 were reviewed. Recipients of retransplantation were divided into the re-DDLT and re-LDLT groups. The groups were compared in demographic characteristics, pre-retransplant and intraoperative details, and short- and long-term outcomes. Risk for living donors was examined.
Twenty-nine patients had 33 re-DDLTs and 15 patients received re-LDLT. The re-LDLT group had lighter grafts (525 vs. 1295 g, p ≤ 0.001), a smaller ratio of graft weight to recipient standard liver volume (56.98 vs. 107.7%, p ≤ 0.001), and shorter cold ischemia (106 vs. 451 min, p ≤ 0.001). The groups were otherwise comparable. Two patients in the re-DDLT group had Grade-5 complication. The groups were similar in patient survival (p = 0.326) and graft survival (p = 0.102). No living donors died, but three of them developed Grade-1 complications.
With the required expertise, re-LDLT can produce results comparable to those of re-DDLT while keeping donor risk at bay. In places where the demand for deceased-donor liver grafts far outstrips supply, re-LDLT can be considered as an alternative to re-DDLT if the expertise is available and if the potential recipient benefits can balance out the potential donor risks.
对于肝移植失败或失功的患者来说，肝移植是唯一的挽救生命的治疗方法，而再次肝移植（re-LDLT）存在很大争议，这是一种合理的选择。本回顾性研究试图确定活体供肝再次肝移植（re-LDLT）是否是已故供体肝再次肝移植（re-DDLT）的合理替代方案。
回顾性分析 2000 年 1 月至 2016 年 4 月期间的肝移植患者匿名数据。将接受再次肝移植的患者分为 re-DDLT 组和 re-LDLT 组。比较两组患者的人口统计学特征、术前和术中细节以及短期和长期结局。评估活体供者的风险。
29 例患者进行了 33 例 re-DDLT，15 例患者接受了 re-LDLT。re-LDLT 组移植物较轻（525g 比 1295g，p≤0.001），供肝与受者标准肝体积比（56.98%比 107.7%，p≤0.001）较小，冷缺血时间（106min 比 451min，p≤0.001）较短。两组其他方面无差异。re-DDLT 组有 2 例患者发生 5 级并发症。两组患者的生存率（p=0.326）和移植物生存率（p=0.102）相似。无活体供者死亡，但其中 3 例发生 1 级并发症。
在具备相关专业知识的情况下，re-LDLT 可以产生与 re-DDLT 相当的结果，同时降低供者风险。在供体肝组织严重短缺的地区，如果有专业知识，并且潜在受者的获益可以平衡潜在供者的风险，re-LDLT 可以作为 re-DDLT 的替代方案。
