肝移植治疗原发性胆汁性肝硬化

Liver transplantation in primary biliary cirrhosis

目的总结肝移植治疗原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)的效果。方法 2002-04至2007-04为15例原发性胆汁性肝硬化患者进行了原位肝移植,对其术前状况进行了Mayo评分,并对随访数据进行了分析。结果 15例入院时平均Mayo评分8.05。均接受了原位肝移植术,术后4例出现共6次急性排斥反应,经过治疗均全部治愈;3例术后新发乙肝,1例新发丙肝;1例顽固性高血糖;1例肝动脉狭窄,经过放置支架后痊愈;1例因胆道弥漫性非吻合口狭窄、肝功能衰竭于术后4个月死亡;1例术后6个月以后失访,失访前状况良好。其余13例平均随访时间47(41～84)个月,目前受者及移植物均存活。围术期生存率100%,排除1人失访,其余14人1年生存率92.9%,3年生存率92.9%。结论在我国肝移植已经成为治疗终末期PBC的有效方法。PBC术后维持较高的免疫抑制水平是必要的,同时要重视预防术后嗜肝病毒感染。

Objective To summarize the effect of liver transplantation in primary biliary cirrhosis （PBC） patients. Methods Orthotopic liver transplantations were performed in 15 PBC patients from May 2002 to May 2007 in this institute. The Mayo score was used for pre - operative evaluation according to their laboratory results on admission. The follow - up data were also analyzed. Results Fifteen patients had an average Mayo score of 8.05. They all underwent orthotopic liver transplantation. After operation, four patients experienced six episodes of acute rejection, which were all cured. Three suffered de novo from hepatitis B infection, one de novo hepatitis C infection, one uncontrolled high blood glucose, one hepatic artery constriction cured by stenting. One died four months after operation from biliary complication, liver failure and severe infection. One patient was out of contact six months after operation and she was well before that. The others were followed up till this year, a median follow -up time of 47 months （29 -70 months）. Except for one patient, one and three year survival rates of recipients and grafts were both 92.9%. Conclusions Liver transplantation has become a most effective treatment for end stage primary biliary cirrhosis. PBC patients should routinely receive prophylactic HBIG injection to prevent de novo HBV infection.