Moon H H, Kim T-S, Song S, Shin M, Chung Y J, Lee S, Choi G S, Kim J M, Kwon C H D, Lee S-K, Joh J
Department of Surgery, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea.
Department of Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
Transplant Proc. 2018 Nov;50(9):2668-2674. doi: 10.1016/j.transproceed.2018.03.040. Epub 2018 Mar 16.
East Asia is a known endemic area for hepatitis B, and living donor liver transplantation is mainly performed. Liver retransplantation (ReLT) is expected to become an increasing problem because of a shortage of organs. This study aimed to compare early and late ReLT with consideration of specific circumstances and disease background of East Asians.
Between October 1996 and January 2015, 51 patients underwent ReLT; we performed a retrospective analysis of data obtained from medical records of the patients. Clinical characteristics, indication, causes of death, survival rate, and prognostic factors were investigated.
The survival rate for early ReLT (n = 18) was 51.5% and that for late ReLT (n = 33) was 50.1% at 1 year postoperatively. Continuous venovenous hemodialysis and the use of mechanical ventilators were more frequent, and pre-retransplant intensive care unit stay and prothrombin time was longer in early ReLT than in late ReLT. Operation time was longer and the amount of intraoperative blood loss was greater in late ReLT than in early ReLT. Multivariate analysis showed that a higher C-reactive protein level increased mortality in early ReLT (P = .045), whereas a higher total bilirubin level increased the risk of death in late ReLT (P = .03).
Patients with early ReLT are likely to be sicker pre-retransplantation and require adequate treatment of the pretransplant infectious disease. On the other hand, late ReLT is likely to be technically more difficult and should be decided before the total bilirubin level increases substantially.
东亚是已知的乙型肝炎流行地区，主要开展活体肝移植。由于器官短缺，肝再次移植（ReLT）预计将成为一个日益严重的问题。本研究旨在结合东亚人的具体情况和疾病背景，比较早期和晚期肝再次移植。
1996年10月至2015年1月期间，51例患者接受了肝再次移植；我们对从患者病历中获取的数据进行了回顾性分析。调查了临床特征、适应证、死亡原因、生存率和预后因素。
术后1年时，早期肝再次移植（n = 18）患者的生存率为51.5%，晚期肝再次移植（n = 33）患者的生存率为50.1%。早期肝再次移植患者持续静脉-静脉血液透析和使用机械通气的频率更高，移植前重症监护病房停留时间和凝血酶原时间比晚期肝再次移植患者更长。晚期肝再次移植的手术时间比早期肝再次移植更长，术中出血量更大。多因素分析显示，较高的C反应蛋白水平增加了早期肝再次移植患者的死亡率（P = .045），而较高的总胆红素水平增加了晚期肝再次移植患者的死亡风险（P = .03）。
早期肝再次移植患者移植前病情可能更严重，需要对移植前感染性疾病进行充分治疗。另一方面，晚期肝再次移植在技术上可能更困难，应在总胆红素水平大幅升高之前做出决定。
