Ding Fan, Tang Hui, Zhao Hui, Feng Xiao, Yang Yang, Chen Gui-Hua, Chen Wen-Jie, Xu Chi
Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China.
Organ Transplantation Institute, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China.
Exp Ther Med. 2019 May;17(5):4183-4189. doi: 10.3892/etm.2019.7449. Epub 2019 Mar 27.
The aim of the present study was to explore the indications for and safety of orthotopic liver transplantation for polycystic liver disease (PLD). Orthotopic liver transplantation in 11 patients with PLD between May 2004 and September 2013 was retrospectively analyzed. Patient epidemiological, clinical and follow-up data were collected. The survival rate was calculated using the Kaplan-Meier method. Over the 10-year period, 11 patients received orthotopic liver transplantation (n=9) and combined liver-kidney transplantation (n=2) for PLD. The recipients' median age was 56 years [(interquartile range (IQR), 52-57 years], and 7 of the patients (63.6%) were classified as having Gigot type II PLD and 4 (36.4%) as having Gigot type III. A total of 8 (72.7%) patients had a severely decreased quality of life (Eastern Cooperative Oncology Group performance status score, ≥3). Only 3 cases (27.3%) were of Class C stage. The mean hospitalization duration was 45.4±15.3 days and the mean length of stay at the intensive care unit was 4.1±1.9 days. The peri-operative mortality was 18.2% and the morbidity was 54.5%. The median follow-up period was 111 months (IQR, 33-132 months). A total of 2 patients died of severe complications after combined liver-kidney transplantation. Furthermore, 1 patient died of ischemia cholangitis during the follow-up period. The actuarial 1-, 5- and 10-year survival rate during the follow-up period was 81.8, 81.8 and 65.5%, respectively. The mean physical component summary score was 87.1±6.9 and the mean mental component summary score was 81.5±6.4. In conclusion, liver transplantation is the only curative procedure for PLD, and the present study indicated that it is relatively and safe and leads to good long-term prognosis and high quality of life. Based on our experience and results, liver transplantation is a primary option for cases of PLD with progressive or advanced symptomatic disease where previous other forms of therapy to palliate symptoms have been insufficient.
本研究的目的是探讨多囊肝病(PLD)原位肝移植的适应证及安全性。对2004年5月至2013年9月期间11例PLD患者的原位肝移植情况进行回顾性分析。收集患者的流行病学、临床及随访数据。采用Kaplan-Meier法计算生存率。在这10年期间,11例患者因PLD接受了原位肝移植(n=9)及肝肾联合移植(n=2)。受者的中位年龄为56岁[四分位间距(IQR),52 - 57岁],其中7例(63.6%)患者为吉戈特II型PLD,4例(36.4%)为吉戈特III型。共有8例(72.7%)患者生活质量严重下降(东部肿瘤协作组体能状态评分,≥3)。仅3例(27.3%)为C级阶段。平均住院时间为45.4±15.3天,在重症监护病房的平均停留时间为4.1±1.9天。围手术期死亡率为18.2%,发病率为54.5%。中位随访期为111个月(IQR,33 - 132个月)。共有2例患者在肝肾联合移植后死于严重并发症。此外,1例患者在随访期间死于缺血性胆管炎。随访期间1年、5年和10年的精算生存率分别为81.8%、81.8%和65.5%。平均生理功能综合评分87.1±6.9,平均心理功能综合评分81.5±6.4。总之,肝移植是PLD唯一的治愈性治疗方法,本研究表明其相对安全,能带来良好的长期预后及较高的生活质量。基于我们的经验和结果,对于有进行性或晚期症状性疾病且既往其他缓解症状的治疗方法不足的PLD病例,肝移植是首选方案。