- Universidade Federal do Paraná, Departamento de Clínica Cirúrgica do Complexo Hospital de Clínicas - Curitiba - PR - Brasil.
- Hospital Nossa Senhora das Graças, Serviço de cirurgia do aparelho digestivo e transplante.
Rev Col Bras Cir. 2024 Jul 5;51:e20243689. doi: 10.1590/0100-6991e-20243689-en. eCollection 2024.
retransplantation is the only viable treatment for patients with irreversible graft loss. The objective of this study was to analyze the indications and outcomes of liver retransplantation in three medical centers.
a total of 66 patients who underwent liver retransplantation from September 1991 to December 2021 were included in the study. A retrospective analysis was performed evaluating patients demographic, clinical, primary diagnosis, indications for and time interval to retransplantation, complications and patient survival.
from a total of 1293 primary liver transplants performed, 70 required one or more liver retransplant. The main indication for primary transplant was hepatitis C cirrhosis (21,2%). Hepatic artery thrombosis was the main cause of retransplantation (60,6%), with almost half (46,9%) of retransplants having occurred within 30 days from initial procedure. The average survival time after a repeat liver transplant, was 89,1 months, with confidence interval from 54 to 124,2. The 1-,5- and 10- year survival rate following liver retransplant were 48,4%, 38% and 30,1%, respectively. Male gender, primary non function as the cause for retransplant, prolonged operative time and higher MELD were associated with higher mortality.
operative mortality and morbidity rates of liver retransplantation are higher than those of the first transplantation. Male gender, primary non function, prolonged operative time and higher MELD were associated with less favorable outcomes.
再移植是治疗不可逆移植物失功患者的唯一可行方法。本研究的目的是分析三个医学中心的肝再移植的适应证和结果。
本研究共纳入 1991 年 9 月至 2021 年 12 月期间接受肝再移植的 66 例患者。对患者的人口统计学、临床、原发性诊断、再移植的适应证和时间间隔、并发症以及患者生存情况进行回顾性分析。
在总共进行的 1293 例原发性肝移植中，有 70 例需要进行一次或多次肝再移植。原发性移植的主要适应证是丙型肝炎肝硬化（21.2%）。肝动脉血栓形成是再移植的主要原因（60.6%），其中近一半（46.9%）再移植发生在初始手术 30 天内。重复肝移植后的平均生存时间为 89.1 个月，置信区间为 54 至 124.2。肝再移植后 1、5 和 10 年的生存率分别为 48.4%、38%和 30.1%。男性、原发性无功能作为再移植的原因、手术时间延长和更高的 MELD 与更高的死亡率相关。
肝再移植的手术死亡率和发病率高于首次移植。男性、原发性无功能、手术时间延长和更高的 MELD 与预后不良相关。
