肝移植治疗终末期酒精性肝病

Liver transplantation for end-stage alcoholic liver disease

目的评价肝移植治疗终末期酒精性肝病(alcoholic liver disease,ALD)的可行性及疗效。方法回顾性地分析中山大学附属第三医院2003年12月至2007年4月进行的18例终末期ALD病人接受肝移植治疗后的生存情况及主要并发症发生率。结果18例ALD和229例非ALD良性终末期肝病病人肝移植术后1、2、3年存活率分别为88.9%、77.8%、77.8%和90.4%、84.0%和78.2%,两组间存活率的差异无统计学意义(P=0.778)。两组术后并发症的发生率分别为:肺部感染44.4%(8/18)和33.2%(76/229)(P=0.538),胆道并发症16.7%(3/18)和24.9%(57/229)(P=0.574),动脉并发症11.1%(2/18)和7.0%(16/229)(P=0.628),排斥反应11.1%(2/18)和6.6%(15/229)(P=0.357)。ALD组术后5.6%(1/18)恢复少量饮酒,没有病人重新出现酒精依赖。结论肝移植是治疗终末期酒精性肝病的有效手段,术后生存情况和非ALD良性终末期肝病接近。感染性并发症是ALD肝移植术后最主要的死亡原因,移植后应加强感染性并发症的监测和治疗。

Objective To evaluate the efficacy of liver transplantation （LT） in patients with end-stage liver alcoholic disease （ALD）. Methods The results were analyzed retrospectively for 18 patients, who underwent LT for ALD from December 2003 to April 2007 at Liver Transplant Center of Third Affiliated Hospital of Sun Yat-sen University. Results The 1, 2 and 3-year survival rates of ALD group and Non-ALD group were 88.9%, 77.8%, 77.8% and 90.4%, 84.0%, 78.2% respectively. There was no significant difference between 1, 2 and 3-Year survival rates between this two groups （P = 0.778）. Lung-infection rate after LT between ALD group and Non ALD group were： 44.4% （8/18） and 33.2% （76/229） （P =0.538）; Biliary tract complications： 16.7% （3/18） and 24.9% （57/229） （P =0.574）; Hepatic arterial complications 11.1% （2/18） and 7.0% （16/229） （P =0.628）; Rejection 11.1% （2/18） and 6.6% （15/229） （P =0.357）. There was only one person who resumed mild, intermittent drinking after LT. Conclusion End-stage ALD is a good indication for LT with similar results in non-ALD patients. The major cause of death in ALD patients after LT is infection complications. More attention is needed for the prophylaxis infectious complications after LT.