再次肝移植治疗移植肝失功能22例报告

Retransplantation for liver transplanter with poor graft function:a report of 22 cases

目的 总结再次肝移植治疗移植肝失功能的临床经验。方法 回顾分析2004年1月至2006年6月期间中山大学附属第三医院施行22例再次肝移植受者的临床资料，结合文献加以讨论。再次肝移植的原因分别为移植术后胆道并发症（12例）、移植术后肝癌复发（4例）、肝动脉栓塞（2例）、肝动脉狭窄（2例）以及乙肝复发（2例）。再次移植率为3．62％，供肝植入均采用改良背驮式肝移植技术。结果 全组无手术死亡，8例随访至今分别存活21、14、8、3个月各1例，12、1个月各2例；14例存活2周到28个月不等。首次肝移植术后8～30d行再次肝移植病人围手术期病死率最高，为66．7％；1年内死亡10例，主要死亡原因为感染（60％）。结论 再次肝移植是移植肝失功能的惟一有效的治疗方法，正确掌握手术时机及适应证，钻研手术技巧，合理的个体化免疫抑制方案以及围手术期有效的抗感染治疗是提高再次肝移植病人存活率的关键。

Objective To sum up the clinical experience of liver retransplantation （ReTx） for patients with poor graft function. Methods The clinical data of 22 patients performed liver retransplantation at the Organ Transplant Institute of Sun Yat-sen University from January 2004 to June 2006 were analyzed retrospectively. The indications included biliary complications （12 patients） ,recurrence of HCC （4 patients） ,hepatic artery thrombosis （HAT） （2 patients） ,hepatic artery stricture （2 patients） and hepatitis B recurrence （2 patients）. The rate of retransplantation was 3. 62%. All the patients received piggyback liver transplantation with cadaveric allografts. Results No perioperative mortality occurred. Eight patients were cured with the survival time being 21 months, 14 months, 12 months, 12 months,8 months,3 months, 1 month, 1 month. Other 14 patients survived from 2 weeks to 28 months. The perioperation mortality rate of patients performed retransplantation between 8 and 30 clays after their initial transplantation was the highest （ 66.7% ）. Ten patients were died of sepsis-related （60%） within 1 year. Conclusion Liver retransplantation is the only effective treatment for liver transplanter with poor graft function after liver transplantation. Proper indication and optimum operation time, surgical procedure, reasonable individual immunosupppression regime and effective perioperative anti-infection treatment contribute to the increase of the survival rate of the patients performed liver retransplantion.