肝肺综合征患者肝移植术后长期随访结果和预后分析

Liver transplantation for patients with hepatopulmonary syndrome： long-term follow-up and prognosis analysis

目的 分析肝肺综合征（HPS）患者接受肝移植治疗的临床疗效.方法 回顾性分析我院420例成人肝移植的临床资料.其中HPS患者91例,非HPS患者329例.分析两组患者术后5年随访结果和生存情况.结果 非HPS与HPS两组患者在年龄、原发病、Child-Pugh评分、MELD评分、冷缺血时间、热缺血时间、无肝期等方面差异无统计学意义,术前血清白蛋白[（29.6±1.2） g/L比（26.4±1.6） g/L]与血氧分压[（61.0±9.0）mmHg（1 mmHg =0.133 kPa）比（87.0±6.0） mmHg]差异有统计学意义（P＜0.05）.HPS患者肝移植术后1年的治愈率为65.9％（60/91）.非HPS组患者术后1、3、5年累积生存率分别为97.3％、90.9％和80.3％,死亡原因主要为原发性移植物功能障碍、心血管事件和原发病复发或肿瘤等.HPS患者1、3、5年累积生存率分别为65.9％、59.3％和56.0％,死亡原因主要为多器官功能衰竭、肺部感染、脑血管事件等.Kaplan-Meier生存曲线分析显示,HPS患者肝移植术后生存率显著低于非HPS患者（P＜0.05）.结论 肝移植是治疗合并HPS的终末期肝病患者的有效方法,但术后短期病死率高.临床仍需进一步研究提高HPS患者肝移植术后生存率.

Objeetive To analyze the clinical efficacy of liver transplantation （OLT） for patients with hepatopulmonary syndrome （HPS）.Methods From 2008 to 2013,420 adult patients underwent liver transplantation in our hospital.There were 91 patients with,and 329 patients without,HPS.The 5-year survival and mortality rates after OLT for the two groups were retrospectively analyzed.Results There were no significant differences between patients without and with HPS in age,primary disease,Child-Pugh score,MELD score,cold ischemia time and warm ischemia time.However,the differences on serum albumin [（29.6 ± 1.2） g/L vs.（26.4 ± 1.6） g/L] and blood oxygen pressure [（61.0 ±9.0） mmHg （1 mmHg =0.133 kPa） vs.（87.0 ± 6.0） mmHg] were significantly different （P 〈 0.05）.The 1-year cure rate was 65.9% （60/91） in 91 patients with HPS after liver transplantation.The 1,3,5-year cumulative survival rates for patients without HPS were 97.3%,90.9% and 80.3%,respectively,and the main causes of death were primary graft dysfunction,recurrent cardiovascular events and primary disease recurrence or tumors.The 1,3,5-year cumulative survival rates for patients with HPS were 65.9%,59.3% and 56.0%,and the main causes of death were multiple-organ failure,pulmonary infection and cerebrovascular events.Kaplan-Meier survival curve analysis showed that the survival of patients with HPS was significantly lower than that of patients without HPS （P 〈 0.05）.Conclusions Liver transplantation is the most effective treatment for patients with HPS,but the short-term mortality rate is relatively high.We still need to learn more about HPS to improve the survival rate of patients with HPS after liver transplantation.