摘要
BACKGROUND:Liver resection after liver transplantation is a relatively uncommon procedure.Indications for liver resection include hepatic artery thrombosis(HAT),non- anastomotic biliary stricture(ischemic biliary lesions), liver abscess,liver trauma and recurrence of hepatocellular carcinoma(HCC).Organ shortage and lower survival after re-transplantation have encouraged us to make attempts at graft salvage. METHODS:Eleven resections at a mean of 59 months after liver transplantation were made over 18 years.Indications for liver resection included HCC recurrence in 4 patients, ischemic cholangiopathy,segmental HAT,sepsis and infected hematoma in 2 each,and ischemic segmentⅣafter split liver transplantation in 1. RESULTS:There was no perioperative mortality.Morbidity included one re-laparotomy for small bowel perforation, one bile leak treated conservatively,one right subphrenic collection,one wound infection and 5 episodes of Gram- negative sepsis.One patient underwent re-transplantation 4 months after resection for chronic rejection.There were 3 deaths,two from HCC recurrence and one from post- transplant lymphoproliferative disorder.The overall mean follow-up after resection was 48 months. CONCLUSIONS:Liver resection in liver transplant recipients is safe,and has good outcome in selected patients and avoids re-transplantation in the majority of patients. Recipients with recurrent HCC in graft may benefit from resection,but cure is uncommon.
BACKGROUND:Liver resection after liver transplantation is a relatively uncommon procedure.Indications for liver resection include hepatic artery thrombosis(HAT),non- anastomotic biliary stricture(ischemic biliary lesions), liver abscess,liver trauma and recurrence of hepatocellular carcinoma(HCC).Organ shortage and lower survival after re-transplantation have encouraged us to make attempts at graft salvage. METHODS:Eleven resections at a mean of 59 months after liver transplantation were made over 18 years.Indications for liver resection included HCC recurrence in 4 patients, ischemic cholangiopathy,segmental HAT,sepsis and infected hematoma in 2 each,and ischemic segmentⅣafter split liver transplantation in 1. RESULTS:There was no perioperative mortality.Morbidity included one re-laparotomy for small bowel perforation, one bile leak treated conservatively,one right subphrenic collection,one wound infection and 5 episodes of Gram- negative sepsis.One patient underwent re-transplantation 4 months after resection for chronic rejection.There were 3 deaths,two from HCC recurrence and one from post- transplant lymphoproliferative disorder.The overall mean follow-up after resection was 48 months. CONCLUSIONS:Liver resection in liver transplant recipients is safe,and has good outcome in selected patients and avoids re-transplantation in the majority of patients. Recipients with recurrent HCC in graft may benefit from resection,but cure is uncommon.
