成人良性终末期肝病肝移植术后中远期生存分析

Long-term survival after liver transplantation for benign end-stage liver disease in adults

目的了解成人良性终末期肝病肝移植术后中远期的生存情况和影响中远期生存率的因素。方法回顾性地分析2003年10月至2006年5月203例良性终末期肝病肝移植术后生存期大于1年的165例受体的长期随访结果，包括各种并发症的发生率及相关死亡率。结果肝移植术后1、2、3年的生存率分别为88．7％、85．5％、81．2％；乙肝相关性疾病受体2、3年生存率分别为88．4％和84．5％，非乙肝相关性疾病2、3年的生存率83．4％和77．0％，两组差异无统计学意义（P=0．144）。存活大于1年的165例中，1年后死亡21例，平均死亡时间22．7±6．6月（12—48个月）。1年后导致受体死亡的主要并发症及其病死率为：感染并发症4．8％（8／165）、胆道并发症3．6％（6／165）、乙肝病毒再感染1．8％（3／165）、慢性排斥反应1．2％（2／165）、肾功能损害0．6％（1／165）和肝动脉并发症0．6％（1／165）等。结论良性终末期肝病肝移植术后中远期生存情况良好。影响患者术后中远期存活的主要原因是感染并发症、胆道并发症和HBV再感染。

Objective To evaluate the long-term survival rates of the adults with benign end-stage liver disease （BELD） after liver transplantation （LT） and the causes of death. Methods The common causes of late death （after more than 1 year） after LT were retrospectively analyzed in 203 consecutive patients with BELD who underwent LT from Oct. 2003 to May. 2006. Results The 1,2 and 3-year survival rates were 88.7%, 85.5%, and 81.2% respectively. The 2-year and 3-year survival rates of the patients with HBV-related liver disease were 88.4% and 84. 5% respectively, not significantly different from those of patients with non-HBV-related liver disease （75.6% and 64. 0% respectively, P = 0. 144） . 165 recipients survived for more than 1 year and 21 recipients died during the period between 12 and 48 months after LT with a mean of （ 22. 7 ± 6. 6 ） months. The common causes of late death included related to infectious complications （4. 8%, 8/165 ）, biliary tract complications （3.6%, 6/165 ）, HBV re-infection （1.8%, 3/ 165）, chronic rejection （1.2%, 2/165）, renal functional lesion （0. 6%, 1/165）, and hepatic arterial complication （0. 6% 1/165 ）. Conclusion Satisfactory long-term survival can be achieved in most adult recipients with BELD after LT and the major causes that influenee the long-term survival are infectious complications, biliary tract complications, and HBV re-infection. Prevention of these complications, rational use of immunosuppressant, and regular follow-up are essential to improve long-term survival.