Shi Rui, Liu Tong, Liu Zirong, Zhang Yamin, Shen Zhongyang
Organ Transplantation Center, The First Central Hospital of Tianjin, Tianjin, China (mainland).
Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland).
Ann Transplant. 2018 Mar 20;23:190-196. doi: 10.12659/AOT.907240.
BACKGROUND The aim of this study was to classify ischemia-type biliary lesions after liver transplantation according to their imaging findings and severity of clinical manifestations and to analyze the relationship between such classification and prognosis. MATERIAL AND METHODS We collected clinical data of patients with ischemia-type biliary lesions (ITBL) after liver transplantation in the Organ Transplantation Center, the First Central Hospital of Tianjin, from August 2012 to July 2013; all patients were classified according to their imaging findings and relevant clinical data to analyze the relationship between their classification and prognosis. RESULTS The mean postoperative survival time, as well as the 1-, 3-, and 5-year survival rate, in Group ITBL showed statistical significance when compared with those in Group NITBL (log rank=12.13, P<0.001), but the mean postoperative survival times among the mild, moderate, and severe ITBL cases showed no statistical significance. The incidence rates of 1-, 3-, and 5-year adverse prognosis in Group ITBL showed statistical significance when compared with Group NITBL with <2% patients who had anastomotic biliary obstruction (log rank=277.06, P<0.001), among which the difference in the incidence rate of adverse prognosis between severe and moderate ITBL cases showed no statistical significance. The difference in the incidence rate of adverse prognosis between mild and moderate ITBL cases showed statistical significance (log rank=6.01, P=0.014), and the difference in the incidence rate of adverse prognosis between mild and severe ITBL cases showed statistical significance (log rank=10.98, P=0.001). CONCLUSIONS ITBL classification based on the severity of biliary imaging and bilirubin level can predict the prognosis of ITBL.
背景 本研究旨在根据肝移植术后缺血型胆管病变的影像学表现及临床表现严重程度对其进行分类，并分析这种分类与预后的关系。
材料与方法 收集天津市第一中心医院器官移植中心2012年8月至2013年7月肝移植术后缺血型胆管病变（ITBL）患者的临床资料；根据患者的影像学表现及相关临床资料进行分类，分析其分类与预后的关系。
结果 ITBL组术后平均生存时间以及1年、3年和5年生存率与非ITBL组相比有统计学意义（对数秩检验=12.13，P<0.001），但轻度、中度和重度ITBL病例的术后平均生存时间无统计学意义。ITBL组1年、3年和5年不良预后发生率与非ITBL组相比有统计学意义（<2%的患者有吻合口胆管梗阻，对数秩检验=277.06，P<0.001），其中重度与中度ITBL病例不良预后发生率差异无统计学意义。轻度与中度ITBL病例不良预后发生率差异有统计学意义（对数秩检验=6.01，P=0.014），轻度与重度ITBL病例不良预后发生率差异有统计学意义（对数秩检验=10.98，P=0.001）。
结论 基于胆管影像学严重程度和胆红素水平的ITBL分类可预测ITBL的预后。
