再次肝移植8例临床分析

Clinical Experience of Liver Retransplantation in 8 Patients

目的 总结再次肝移植的临床经验。方法 2002年6月～2005年12月，共施行185例肝移植，其中再次肝移植8例，回顾性分析该8例患者的临床资料。结果 本组再移植率4．32％。首次肝移植和再次肝移植前病人终末期肝病模型（MELD）评分平均为15．6分和23．9分；再次肝移植距首次肝移植的时间间隔平均为316d（78～725 d）；再次肝移植原因中胆道并发症3例，慢性排异2例，肝动脉栓塞、急性排异、乙型肝炎复发各1例。8例患者均平稳渡过手术期，前3例病人分别于术后第101、16和28天因严重感染合并多脏器功能衰竭而死亡，后5例病人均康复出院，存活至今达27、12、8、4和3个月。结论 再次肝移植是挽救移植肝失功的有效手段。正确掌握手术指征，合理选择手术时机，以及手术技巧的不断完善和围手术期的精心处置，是提高再次肝移植成功的关键。

Objective To summarize the clinical experience in liver retransplantation. Methods From June 2002 to December 2005, a total of 185 cases of liver transplantation were performed in our hospital, including 8 cases of retransplantation. Those clinical data were analyzed retrospectively. Results The rate of liver retransplantation was 4.32%. The average MELD scores before primary transplantation and retransplantation were 15.6 and 23.9, respectively. The average interval between primary transplantation and retransplantation was 316 days （78～725 days）. Causes of retransplantation included 3 cases of biliary complications, 2 cases of chronic rejection, 1 case of hepatic artery thrombosis, 1 case of acute rejection and 1 case of recurrence of hepatitis B. The former 3 cases died of severe infection combined with multiple organ failure 101, 16 and 28 days after retransplantation. The latter 5 cases recovered smoothly, and have survived 27, 12, 8, 4 and 3 months up to now. Conclusion Liver retransplantation is an effective way to save the patient with hepatic allograft failure. Good knowledge of the indications of retransplantation, careful selection of the operation time, excellent surgical skills and meticulous postoperative management will contribute to the success of liver retransplantation.