肝移植后慢性移植肝失功的病因诊断和治疗18例

Etiological diagnosis and management of chronic graft dysfunction after liver transptantation:an analysis of 18 cases

目的:探讨肝移植后慢性移植肝失功的病因诊断和治疗.方法:回顾性分析我院1996-01/2006-12完成的291例原位肝移植中18例肝移植后慢性移植肝失功患者的临床资料,总结肝移植后慢性移植肝失功的病因及诊断和治疗.结果:18例肝移植后慢性移植肝失功患者发生反复胆道感染2例、胆管广泛胆泥2例、胆管吻合口狭窄1例、胆管非吻合口狭窄4例、乙型肝炎复发3例、丙型肝炎复发1例、胆汁性肝硬化1例、肝动脉狭窄1例、巨细胞病毒(CMV)感染1例和慢性排斥反应2例.通过各种内科支持治疗、介入治疗或再次肝移植,11例好转,4例病情反复,3例死亡.结论:根据肝移植后慢性移植肝失功的不同病因,可采取不同的治疗手段;对于不可逆转的移植肝功能衰竭,应进行再次肝移植.

AIM： To analyze the etiology, diagnosis and management of chronic graft dysfunction after liver transplantation. METHODS： A total of 291cases underwent orthotopic liver transplantation in our hospital from Janunary 1996 to December 2006. The clinical data of 18 cases with chronic graft dysfunction after liver transplantation were analyzed retrospectively. RESULTS： Of 18 patients with chronic graft dysfunction after liver transplantation, 2 were found with recurrent biliary inflammation, 2 with biliary sludge, 1 with anastomotic biliary stricture, 4 with nonanastomotic biliary stricture, 3 with reccurent hepatitis B, I with recurrent hepatitis C,1 with recurrent primary biliary cirrhosis, 1with hepatic artery stricture, 1 with cytomegalovirus （CMV） infection and 2 with chronic rejection. After different medical support treatment, intervention or liver reransplantation, 11 patients were improved, and 4 cases were found with recurrent diseases. The rest 3 cases died. CONCLUSION： Different therapeutic approaches may be taken in accordance with different causes of chronic graft dysfunction after liver transplantation. For irreversible hepatic allograft failure, liver re-transplantation should be carried out.