Pohl Julian M O, Raschzok Nathanael, Eurich Dennis, Pflüger Michael, Wiering Leke, Daneshgar Assal, Dziodzio Tomasz, Jara Maximilian, Globke Brigitta, Sauer Igor M, Biebl Matthias, Lurje Georg, Schöning Wenzel, Schmelzle Moritz, Tacke Frank, Pratschke Johann, Ritschl Paul V, Öllinger Robert
Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Experimental Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.
BIH Charité Clinician Scientist Program, Berlin Institute of Health (BIH), 13353 Berlin, Germany.
J Clin Med. 2020 Nov 17;9(11):3685. doi: 10.3390/jcm9113685.
Although more than one million liver transplantations have been carried out worldwide, the literature on liver resections in transplanted livers is scarce. We herein report a total number of fourteen patients, who underwent liver resection after liver transplantation (LT) between September 2004 and 2017. Hepatocellular carcinomas and biliary tree pathologies were the predominant indications for liver resection (n = 5 each); other indications were abscesses (n = 2), post-transplant lymphoproliferative disease (n = 1) and one benign tumor. Liver resection was performed at a median of 120 months (interquartile range (IQR): 56.5-199.25) after LT with a preoperative Model for End-Stage Liver Disease (MELD) score of 11 (IQR: 6.75-21). Severe complications greater than Clavien-Dindo Grade III occurred in 5 out of 14 patients (36%). We compared liver resection patients, who had a treatment option of retransplantation (ReLT), with actual ReLTs (excluding early graft failure or rejection, n = 44). Bearing in mind that late ReLT was carried out at a median of 117 months after first transplantation and a median of MELD of 32 (IQR: 17.5-37); three-year survival following liver resection after LT was similar to late ReLT (50.0% vs. 59.1%; = 0.733). Compared to ReLT, liver resection after LT is a rare surgical procedure with significantly shorter hospital (mean 25, IQR: 8.75-49; = 0.034) and ICU stays (mean 2, IQR: 1-8; < 0.001), acceptable complications and survival rates.
尽管全球已进行了超过100万例肝移植手术，但关于移植肝肝切除术的文献却很少。我们在此报告了2004年9月至2017年间14例肝移植后接受肝切除术的患者。肝细胞癌和胆管树病变是肝切除的主要适应证（各5例）；其他适应证包括肝脓肿（2例）、移植后淋巴增殖性疾病（1例）和1例良性肿瘤。肝切除在肝移植后中位时间120个月（四分位间距（IQR）：56.5 - 199.25）进行，术前终末期肝病模型（MELD）评分为11（IQR：6.75 - 21）。14例患者中有5例（36%）发生了大于Clavien - DindoⅢ级的严重并发症。我们将有再次移植（ReLT）治疗选择的肝切除患者与实际再次移植患者（不包括早期移植物功能衰竭或排斥反应，n = 44）进行了比较。考虑到晚期再次移植在首次移植后中位时间117个月进行，中位MELD评分为32（IQR：17.5 - 37）；肝移植后肝切除术后三年生存率与晚期再次移植相似（50.0%对59.1%；P = 0.733）。与再次移植相比，肝移植后肝切除是一种罕见的手术，住院时间（平均25天，IQR：8.75 - 49；P = 0.034）和重症监护病房停留时间（平均2天，IQR：1 - 8；P < 0.001）显著缩短，并发症和生存率可接受。
