50例肝移植术后近期高胆红素血症的原因及处理

The etiology and management of early postoperative hyperbilirubinemia after liver transplantation

目的 探讨原位肝移植术后近期高胆红素血症的原因及其处理。方法 采用临床与系列肝穿刺活检相对比的方法 ,回顾性分析了 5 0例肝移植术后 3个月内高胆红素血症的原因及其动态变化。结果 肝移植术后血总胆红素 ( μmol/L)的变化曲线形如一个倒“S”型 ,1周内血胆红素皆逐渐升高 ( 12 7.19± 113 .15 ) ,2周内达高峰 ( 135 .45± 12 4.16 ) ,3周始下降 ,4周时平均为 73 .10± 49.5 2 ,至术后 12周可恢复至接近正常水平 ( 2 9.8± 37.5 6 ) ,与镜下肝细胞形态修复过程相一致。术前高胆红素血症 ( 10例 ,2 0 % )、保存损伤 (含缺血再灌注损伤共 44例 ,88% )、急性排斥反应 ( 13例 ,2 6 % )及胆漏 ( 4例 ,8% )系术后高胆红素血症的 4个主要原因 ,其血总胆红素变化趋势曲线相近 ,无原因特征性曲线。 5 0例肝移植术后无原发性肝无功能 ,受者围手术期及移植物生存率为 90 .6 % ,1年生存率约为 80 %。高胆红素血症临床治愈率为 10 0 %。结论 肝移植术后发生高胆红素血症的四大原因分别为 :保存损伤、排斥反应、术前高胆红素血症及胆道并发症。针对其原因 ,进行综合处理 ,常可取得好的临床效果。

Objective To investigate the etiology and management of early postoperative hyperbilirubinemia after liver transplantation. Methods The etiology and dynamic alteration of early postoperative hyperbilirubinemia in 50 liver transplants were retrospectively analyzed by a comparative trial of clinical manifestation with serial liver biopsy. Results The total serum bilirubin (TB) level profile presented like a invert 'S' curve. At the first week, second week and 4th week after liver transplantation the serum TB levels were in average ( 127.19± 113.15)? ( 135.45± 124.6) and ( 73.1± 49.52)?μmol/L respectively. Three months later, the serum TB level approximated to normal TB level ( 29.8± 37.56)?μmol/L. The dynamic alternations of total serum bilirubin level were incorporated with the morphological improvement under microscopy of liver allograft following liver transplantation. The initial hyperbilirubinemia of reciepient before liver transplantation (10 cases, 20?%), preservation injury (containing 44 cases of ischemic reperfusion injury, 88?%), acute cellular rejection (13 cases, 26?%) and bile duct leakage (4 cases, 8?%) were 4 essential causes responsible for the early postoperative hyperbilirubinemia. The total serum bilirubin level profile was not characteristic of each catergory. Those 4 casuses mentioned above presented either independently or concomitantly in concrete case. No primary hepatic failure (PHF) occurred and curability of hyperbilirubinemia was about 100?% in our series. Furthermore, the perioperative survival rate of the recipients and liver allograft was 90.6?% and 1-year accumulative survival rate was about 80?%.Conclusions The hyperbilirubinemia is common clinical manifestion within 3 months after liver transplantation. Preservative injury, acute rejection, preoperative hyperbilirubinemina and bile duct leakage are four essential causes. The comprehensive management targeted to etiology can usually achieve a good outcome for the reciepients with hyperbilirubinemia.