再次肝移植的原因与预后分析

Analysis on Causes and Prognosis of Liver Retransplantation

目的探讨再次肝移植的原因和预后。方法回顾性分析2003年11月26日至2012年5月26日期间笔者所在医院行再次肝移植215例患者的临床资料,分析其再次肝移植的原因与预后。结果笔者所在医院完成再次肝移植215例,其中行2次肝移植200例,3次肝移植14例,4次肝移植1例。第2次肝移植的主要原因为胆道并发症(53.5%,115/215),其次为肝移植物原发性无功能或功能低下(8.4%,18/215);第3次肝移植的原因主要为胆道并发症(5/14),其次为肝癌复发(2/14)。早期(肝移植术后1个月内)与后期(肝移植术后1个月后)第2次肝移植移植物生存率比较差异有统计学意义(P=0.005),后期第2次肝移植移植物生存率较高。第3次肝移植移植物生存率低于第2次肝移植(P=0.043)。与胆道并发症者比较,肝癌复发者(P=0.001)和肝移植物原发性无功能或功能低下者(P=0.033)移植物生存率较低,慢性移植肝失功能者移植物生存率较高(P=0.037)。结论胆道并发症为再次肝移植的最主要原因。移植后早期行再次肝移植的效果不佳,其主要原因是围手术期的死亡增加。因肝癌复发而行再次肝移植患者移植物的预后不理想,而慢性移植肝失功能患者移植物的预后最佳。

Objective To explore the causes and prognosis of liver retransplantation.Methods The clinical data of 215 cases who had underwent liver retransplantation in Tianjin First Central Hospital between Nov.26th 2003 and May.26th 2012 were analyzed retrospectively for its causes and prognosis.Results Two hundreds and fifteen cases were enrolled,including 200 cases of 2 times liver transplantation,14 cases of 3 times liver transplantation,and 1 case of 4 times liver transplantation.The major causes of the second liver transplantation were biliary complication（53.5%,115/215） and primary non-function or dysfunction of liver graft（8.4%,18/215）,and the major causes of the third liver transplantation were biliary complication（5/14） and hepatocellular carcinoma recurrence（2/14）.The liver graft survival rate of late liver retransplantation（at least 1 month after operation） was significantly higher than that of early liver retransplantation（less than 1 month after operation） for the second liver transplantation（P=0.005）.The liver graft survival rate of the second liver transplantation was significantly higher than that of the third liver transplantation（P=0.043）.Compared with biliary complication,cases of hepatocellular carcinoma recurrence（P=0.001） and primary non-function or dysfunction of liver graft（P=0.033） had lower graft survival rates,while cases of chronic failure of liver graft had a higher survival rate（P=0.037）.Conclusions Biliary complication is the main cause of liver retransplantation.The liver retransplantations which are performed less than 1 month after prior liver transplantation result in a relative low survival rate in reason of the increase of perioperative death.The prognosis of liver retransplantation for hepatocellular carcinoma recurrence is unacceptable,while cases of chronic failure of liver graft have optimal prognosis.