Jeffrey Angus W, Delriviere Luc, McCaughan Geoff, Crawford Michael, Angus Peter, Jones Robert, Macdonald Graeme A, Fawcett Jonathan, Wigg Alan, Chen John, Gane Ed, Munn Stephen, Jeffrey Gary P
Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia.
Department of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Sydney, Australia.
Transplant Direct. 2019 Jul 23;5(8):e472. doi: 10.1097/TXD.0000000000000920. eCollection 2019 Aug.
Liver retransplantation is technically challenging, and historical outcomes are significantly worse than for first transplantations. This study aimed to assess graft and patient survival in all Australian and New Zealand liver transplantation units.
A retrospective cohort analysis was performed using data from the Australia and New Zealand Liver Transplant Registry. Graft and patient survival were analyzed according to era. Cox regression was used to determine recipient, donor, or intraoperative variables associated with outcomes.
Between 1986 and 2017, Australia and New Zealand performed 4514 adult liver transplants, 302 (6.7%) of which were retransplantations (278 with 2, 22 with 3, 2 with 4). The main causes of graft failure were hepatic artery or portal vein thrombosis (29%), disease recurrence (21%), and graft nonfunction (15%). Patients retransplanted after 2000 had a graft survival of 85% at 1 year, 75% at 5 years, and 64% at 10 years. Patient survival was 89%, 81%, and 74%, respectively. This was higher than retransplantations before 2000 ( < 0.001). Univariate analysis found that increased recipient age ( = 0.001), recipient weight ( = 0.019), and donor age ( = 0.011) were associated with decreased graft survival prior to 2000; however, only increased patient weight was significant after 2000 ( = 0.041). Multivariate analysis found only increased recipient weight ( = 0.042) and donor age ( = 0.025) was significant prior to 2000. There was no difference in survival for second and third retransplants or comparing time to retransplant.
Australia and New Zealand have excellent survival following liver retransplantation. These contemporary results should be utilized for transplant waitlist methods.
肝脏再次移植在技术上具有挑战性，其历史结果明显比首次移植更差。本研究旨在评估澳大利亚和新西兰所有肝脏移植单位的移植物和患者生存率。
使用来自澳大利亚和新西兰肝脏移植登记处的数据进行回顾性队列分析。根据时代分析移植物和患者生存率。采用Cox回归确定与结果相关的受者、供者或术中变量。
1986年至2017年期间，澳大利亚和新西兰共进行了4514例成人肝脏移植，其中302例（6.7%）为再次移植（278例接受2次移植，22例接受3次移植，2例接受4次移植）。移植物失败的主要原因是肝动脉或门静脉血栓形成（29%）、疾病复发（21%）和移植物无功能（15%）。2000年后接受再次移植的患者1年移植物生存率为85%，5年为75%，10年为64%。患者生存率分别为89%、81%和74%。这高于2000年前的再次移植（<0.001）。单因素分析发现，2000年前受者年龄增加（=0.001）、受者体重增加（=0.019）和供者年龄增加（=0.011）与移植物生存率降低相关；然而，2000年后只有受者体重增加具有统计学意义（=0.041）。多因素分析发现，2000年前只有受者体重增加（=0.042）和供者年龄增加（=0.025）具有统计学意义。第二次和第三次再次移植的生存率或比较再次移植时间方面没有差异。
澳大利亚和新西兰肝脏再次移植后的生存率很高。这些当代结果应用于移植等待名单方法。
