Damaskos C, Kaskantamis A, Garmpis N, Dimitroulis D, Mantas D, Garmpi A, Sakellariou S, Angelou A, Syllaios A, Kostakis A, Lampadariou E, Floros I, Revenas K, Antoniou E A
G Chir. 2019 Nov-Dec;40(6):463-480.
BACKGROUND/AIM: Orthotopic Liver Transplantation (OLT) is the treatment of choice for patients with end stage liver disease, acute liver failure, hepatocellular carcinoma and metabolic disorders. As a result of improvement in surgical and anesthesiological skills, advanced understanding of transplant immunology and better critical care management of complications, patients survive longer after liver transplantation. It has been gradually achieved one-year survival rates of 80-90%. During the early post-operative period, all patients undergoing OLT are admitted to the intensive care unit, as they need a management of both preexisting patient's conditions and post-operative complications, usually due to either adverse intra-operative or post-operative events. The purpose of this review is the detailed recording, understanding and interpretation of immediate post-operative complications occurred in patients undergoing OLT, in intensive care unit. This could help to improve patient's treatment and reduce the incidence of complications, with further reduction of morbidity-mortality and cost. We also present our experience from the first 32 OLT patients from Liver Transplantation Unit of Laiko General Hospital, the only Liver Transplantation Unit in Athens.
This literature review was performed using the MEDLINE database. The key words were; Orthotopic liver transplantation; intensive care unit; post-operative complications; outcomes. One hundred-sixteen articles published in English until 2018 were used. We also use all the results from our 32 patients from our Liver Transplantation Unit during the period 07/2006 to 07/2009.
All patients undergoing OLT admitted to the intensive care unit for a period of time, depending on the occurrence of post-operative complications. The incidence of primary failure ranges between 2-14%, whereas post-operative bleeding ranges between 7-15%. The treatment is usually conservative, although surgical repair may need in 10-15%. Acute renal failure post-operative is not an infrequent problem too, and has been reported to occur in 9% to 78% of cases. Acute rejection normally occurs 7-14 days after OLT. Additionally, the delay of the weaning from mechanical ventilation in the immediate post-operative period could increase the complications. Infectious complications are quite common almost from the first post-operative day in intensive care unit.
Prolonged intensive care stay could increase the complications post-operative Infectious complications, renal and respiratory impairment are among the most common causes of early post-transplant morbidity and mortality.
背景/目的：原位肝移植（OLT）是终末期肝病、急性肝衰竭、肝细胞癌和代谢紊乱患者的首选治疗方法。由于手术和麻醉技术的改进、对移植免疫学的深入理解以及对并发症更好的重症监护管理，肝移植患者的存活时间更长。目前已逐渐实现了80%至90%的一年生存率。在术后早期，所有接受OLT的患者都被收入重症监护病房，因为他们需要对患者术前状况和术后并发症进行管理，这些并发症通常是由术中或术后不良事件引起的。本综述的目的是详细记录、理解和解释在重症监护病房接受OLT的患者术后立即出现的并发症。这有助于改善患者的治疗并降低并发症的发生率，进一步降低发病率、死亡率和成本。我们还介绍了雅典唯一的肝移植单位——拉伊科综合医院肝移植科首批32例OLT患者的经验。
本综述使用MEDLINE数据库进行。关键词为：原位肝移植；重症监护病房；术后并发症；结果。使用了截至2018年以英文发表的116篇文章。我们还使用了2006年7月至2009年7月期间我们肝移植科32例患者的所有结果。
所有接受OLT的患者都要在重症监护病房住院一段时间，具体取决于术后并发症的发生情况。原发性移植肝无功能的发生率在2%至14%之间，而术后出血的发生率在7%至15%之间。治疗通常是保守的，不过10%至15%的患者可能需要手术修复。术后急性肾衰竭也并非罕见问题，据报道其发生率在9%至78%的病例中出现。急性排斥反应通常在OLT术后7至14天发生。此外，术后早期脱机延迟会增加并发症。感染性并发症在重症监护病房几乎从术后第一天起就很常见。
延长重症监护时间会增加术后并发症。感染性并发症、肾脏和呼吸功能损害是移植后早期发病和死亡的最常见原因。
