再次肝移植80例临床报告

Liver retransplantation: report of 80 cases

目的总结再次肝移植的临床经验。方法回顾性分析我中心自1999年1月至2005年7月实施的80例再次肝脏移植的原因、与首次肝移植的时间间隔、选择的术式、1年存活率、围手术期死亡率及死亡的主要病因。结果再次肝移植的主要原因是胆道并发症，占45．0％；距首次移植术后超过1个月再次移植围手术期死亡率（19．6％）明显低于首次移植术后8～30d行再次移植患者（70．0％）；围手术期死亡的主要原因是感染（54．5％）和多脏衰（18．2％）。结论选择合适的手术适应证及手术时间，根据术中情况决定具体术式，制定合理的免疫抑制方案及有效的抗感染治疗是提高再次移植生存率的关键。

Objective To sum up the clinical experience of liver retransplantation. Methods The clinical data of patients receiving liver retransplantation in our department between Jan. 1999 and Jul. 2005 were retrospectively analyzed, the cause of retransplantation, timing of retransplantation, technical considerations and the causes of death. Results The most commen causes of hepatic graft loss and subsequent retransplantation are biliary complications （45.0%）. Patients who received retransplantation more than 30 days after their initial transplant fared better than those who received retransplants between 8 and 30 days after receiving their first one （ mortality rates of perioperation 19.6% versus 70. 0% ）. The development of sepsis （54. 5% ） and multiorgan failure （ 18. 2% ） accounts for the majority of deaths in retransplanted patients. Conclusions Proper indication and optimum operation time, surgical procedure, perioperative monitoring and proper treatment pest operation contribute to the increase of the survival rate of the patients receiving liver retransplantation.