Triguero Cabrera J, Zambudio Carroll N, González Martínez S, Villar Quintana R, Muffak Granero K, Becerra Massare A, Villegas Herrera T, Villar Del Moral J M
Unit of Liver Transplantation, Department of Surgery, Virgen de las Nieves University Hospital, Granada, Spain.
Unit of Liver Transplantation, Department of Surgery, Virgen de las Nieves University Hospital, Granada, Spain.
Transplant Proc. 2018 Mar;50(2):598-600. doi: 10.1016/j.transproceed.2017.12.055.
Liver retransplantation (LrT) is the only therapeutic option for irreversible hepatic graft failure. Despite various improvements, its technical complexity entails a greater morbidity in the short and long term. The main goal of the study was to analyze the activity of LrT at our center, as well as its indications, timing, postoperative evolution, and the long-term survival of patients.
We designed a descriptive study of a cohort of patients who underwent LrT in a Spanish Hepatic Transplant Unit, between April 1, 2002 and December 31, 2015.
A total of 366 primary orthotopic liver transplantations were performed, 20 of which were LrTs, resulting in a 5.5% retransplantation rate. The most frequent indication for LrT was hepatic artery thrombosis (HAT) (35%). Twenty-five percent of the LrTs were early retransplantations and 75% were late retransplantations. After LrT, 35% of the grafts showed liver dysfunction. The overall mortality rate was 45%: in early LrT this was 25% and in late LrT it was 46.7%. Graft actuarial survival at 1 month post-LrT was 75% and at 5 years it was 63.6%. The overall actuarial survival after LrT at month 1, year 1, year 3, and year 5 was 80%, 69.6%, 58.9%, and 50.5%, respectively. In the late LrT group, the results proved less favorable, so it is necessary to define the minimum acceptable result before proceeding to a second graft.
Our LrT rate was lower than that reported by other groups in our country. The actuarial survival rates for graft and patient are comparable to those obtained by other groups.
肝再次移植（LrT）是不可逆肝移植失败的唯一治疗选择。尽管有各种改进，但其技术复杂性在短期和长期都会带来更高的发病率。本研究的主要目的是分析我们中心的LrT活动，以及其适应证、时机、术后演变和患者的长期生存率。
我们设计了一项描述性研究，对象为2002年4月1日至2015年12月31日期间在西班牙一家肝脏移植单位接受LrT的一组患者。
共进行了366例原位肝移植，其中20例为LrT，再次移植率为5.5%。LrT最常见的适应证是肝动脉血栓形成（HAT）（35%）。25%的LrT为早期再次移植，75%为晚期再次移植。LrT后，35%的移植物出现肝功能障碍。总死亡率为45%：早期LrT为25%，晚期LrT为46.7%。LrT后1个月移植物精算生存率为75%，5年时为63.6%。LrT后1个月、1年、3年和5年的总精算生存率分别为80%、69.6%、58.9%和50.5%。在晚期LrT组中，结果较差，因此在进行第二次移植之前有必要确定可接受的最低结果。
我们的LrT率低于我国其他组报告的率。移植物和患者的精算生存率与其他组获得的结果相当。
