Early liver retransplantation versus late liver retransplantation： analysis of a single-center experience  

作　　者：CHEN Gui-hua FU Bin-sheng YANG Yang CAI Chang-jie LU Min-qiang LI Hua WANG Gen-shu YI Shu-hong XU Chi ZHANG Jun-feng ZHANG Tong WANG Guo-ying 

机构地区：[1]Liver Transplantation Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, Guangzhou, Guangdong 510630, China

出　　处：《Chinese Medical Journal》2008年第20期1992-1996,共5页中华医学杂志（英文版）

基　　金：The project was supported by grants from the Major State Basic Research Development Program （973 Program） of China （No. 2003CB515507）, the Guangdong Provincial Natural Science Foundation of China （No. 04105344）, and the Guangdong Provincial Science Technology Project （No. 2005B30501005）.

摘　　要：Background Orthotopic liver retransplantation （re-OLT） is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT. Methods The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.Results Biliary tract complications were the main indications for early re-OLT （57.1%） and late re-OLT （52.9%）. Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease （MELD） score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma （HCC） in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups. Conclusions Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the improvement of overall survival Background Orthotopic liver retransplantation （re-OLT） is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT. Methods The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.Results Biliary tract complications were the main indications for early re-OLT （57.1%） and late re-OLT （52.9%）. Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease （MELD） score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma （HCC） in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups. Conclusions Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the improvement of overall survival

关 键 词：liver transplantation RETRANSPLANTATION survival rate 

分 类 号：R657.3[医药卫生—外科学]