再次肝移植的适应证与死亡原因分析  

Analysis of indications and causes of death in liver retransplantation

作　　者：傅斌生[1,2] 张彤[1,2] 李华[1,2] 易述红[1,2] 汪根树[1,2] 张剑[1,2] 姜楠[1,2] 许赤[1,2] 杨扬[1,2] 蔡常洁[1,2] 陆敏强[1,2] 陈规划[1,2] 

机构地区：[1]中山大学附属第三医院肝移植中心 [2]中山大学器官移植研究所广东省器官移植研究中心,广州510630

出　　处：《器官移植》2011年第6期320-323,共4页Organ Transplantation

基　　金：国家重点基础研究发展计划项目(973分课题)(2009CB522404);国家自然科学基金面上项目(30972914);十一五科技攻关项目(2008ZX10002-025);广东省科技计划项目(2009A030200006);广州省科技计划项目重大专项(2007A032000001);广州市科技计划项目(200921Z1-E211)

摘　　要：目的探讨再次肝移植的适应证和死亡原因。方法回顾性分析2003年9月至2009年7月间在中山大学附属第三医院肝移植中心接受再次肝移植手术的36例患者的临床资料。结果同期该中心再次肝移植率为4.7%。移植术后胆道并发症(53%)是再次肝移植的主要原因,其他常见的原因包括移植术后血管并发症(22%)和原发病的复发(22%)。全组均采用附加腔静脉整形的改良背驮式肝移植术,无手术死亡患者。术后有18例患者死亡,其中7例死于感染性疾病,4例死于肾衰竭和多器官功能衰竭,4例死于肝癌复发,另3例分别死于心肌梗死、颅内出血和血管并发症。另18例患者生存良好并存活至今,移植物功能正常。随访时间24～81个月,中位生存时间54.5个月。再次肝移植患者的1年和3年生存率分别为61%和44%。结论肝移植术后胆道并发症是再次肝移植的主要适应证。再次肝移植的1年和3年生存率较低,感染性疾病是再次肝移植的主要死亡原因。Objective To evaluate the indications and causes of death of liver retransplantation. Methods Clinical data of 36 patients underwent liver retransplantation in Liver Transplantation Center of Third Affiliated Hospital of Sun Yat-sen University from September 2003 to July 2009 were analyzed retrospectively. Results The incidence of liver retransplantation was 4. 7 % in the center during the same period. Biliary tract complications （53 % ）were the main cause for liver retransplantation. Other common causes were vascular complications （22 % ） and recurrence of primary diseases （22 % ）. All the patients received modified piggyback liver transplantation with cavaplasty. No perioperative mortality occurred. Postoperative death occmxed in 18 cases. Seven cases died of severe infection. Four cases died of renal failure and multiple organ failure and 4 cases died of recurrence of hepatocellular carcinoma. Another 3 cases respectively died of myocardial infarction, intracranial hemorrhage and vascular complications. The other 18 patients were still alive with satisfactory graft function. The follow-up time was from 24 to 81 months with the median survival time of 54. 5 months. One and three-year survival rates after liver retransplantation were 61% and 44 %. Conclusion Bile duct complica- tion after liver transplantation is the main indication for liver retransplantation. One and three-year survival rates after liver retransplantation are low and infection disease is the main cause of death in liver retransplantation.

关 键 词：再次肝移植 适应证 胆道并发症 感染 

分 类 号：R657.3[医药卫生—外科学]