39 例酒精性肝炎经内科治疗无效行活体肝移植术患者的疗效分析：单中心经验
Good outcome of living donor liver transplantation for severe alcoholic hepatitis not responding to medical management: A single center experience of 39 patients.
机构信息
Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India.
Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, Delhi (NCR), India.
出版信息
Alcohol. 2019 Jun;77:27-30. doi: 10.1016/j.alcohol.2018.07.009. Epub 2018 Jul 24.
INTRODUCTION
There are limited data on outcomes of living donor liver transplantation (LDLT) for patients with severe alcoholic hepatitis.
METHODS
The study included LDLT recipients for severe alcoholic hepatitis (n = 39) who did not improve with medical treatment and compared their outcomes with patients who underwent LDLT for alcoholic liver disease (n = 461). The diagnosis of severe alcoholic hepatitis was based on both clinical and explants data. No patients had psychiatric contraindications for liver transplant and all had good family support. The data are shown as number, mean (SD), or median (25-75 interquartile range).
RESULTS
All transplant recipients were males, aged 42 ± 8 years. The patients with alcoholic hepatitis were abstinent for a duration of 4 ± 1.8 months at the time of LDLT. All patients underwent LDLT with a graft to recipient weight ratio of 0.95 ± 0.17. The post-transplant ICU and hospital stay were 5.4 ± 1.3 and 17.6 ± 8.4 days, respectively. When patients with alcoholic hepatitis (n = 39) were compared to patients who underwent LDLT for alcoholic liver disease without alcoholic hepatitis (n = 461), patients with alcoholic hepatitis were significantly younger (43.2 ± 8.5 vs. 48.2 ± 9.1 years, p = 0.001) and had higher Child's (10.9 ± 1.5 vs. 9.8 ± 1.8) and MELD scores (22.1 ± 4.5 vs. 18.4 ± 5.9, p = 0.000). Post-operative infections were also significantly more common in the alcoholic hepatitis group (71.7% vs. 51.6%, p = 0.018). Fungal infections developed in 23% of alcoholic hepatitis patients as compared to 14% in the rest of the alcoholic patients (p = 0.247). Six recipients (15.7%) died at a median follow-up of 28 (6-37) months due to infections, and five (12.8%) patients had relapse of alcohol drinking. Survival was not different between the two groups.
CONCLUSION
Living donor liver transplantation can be successfully performed with good survival for patients with severe alcoholic hepatitis.
引言
目前关于接受活体肝移植（LDLT）治疗的重症酒精性肝炎患者的结局数据有限。
方法
本研究纳入了 39 例因药物治疗无效而接受 LDLT 治疗的重症酒精性肝炎患者，并将其与因酒精性肝病接受 LDLT 治疗的 461 例患者的结局进行了比较。重症酒精性肝炎的诊断基于临床和活检数据。所有患者均无肝移植的精神禁忌证，且均有良好的家庭支持。数据以数字、平均值（标准差）或中位数（25-75 四分位间距）表示。
结果
所有肝移植受者均为男性，年龄 42±8 岁。酒精性肝炎患者在 LDLT 时戒酒时间为 4±1.8 个月。所有患者均行 LDLT，供体与受体体重比为 0.95±0.17。术后 ICU 住院时间和总住院时间分别为 5.4±1.3 天和 17.6±8.4 天。与因酒精性肝炎接受 LDLT 治疗的患者（n=39）相比，无酒精性肝炎的因酒精性肝病接受 LDLT 治疗的患者（n=461）年龄明显更小（43.2±8.5 岁 vs. 48.2±9.1 岁，p=0.001），Child 评分（10.9±1.5 分 vs. 9.8±1.8 分，p=0.000）和 MELD 评分（22.1±4.5 分 vs. 18.4±5.9 分，p=0.000）更高。酒精性肝炎组术后感染也明显更常见（71.7% vs. 51.6%，p=0.018）。真菌感染在酒精性肝炎患者中的发生率为 23%，而在其余酒精性肝病患者中为 14%（p=0.247）。6 例受者（15.7%）在中位随访 28（6-37）个月时因感染死亡，5 例（12.8%）患者酒精复饮。两组患者的存活率无差异。
结论
对于重症酒精性肝炎患者，活体肝移植可以成功进行，且患者的存活率良好。
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