BACKGROUND: Fulminant hepatic failure manifests a rapid onset, serious complications, and a high mortality, but still there is a possibility of recovery. Once the patient is able to pass a crisis, the liver is able to...BACKGROUND: Fulminant hepatic failure manifests a rapid onset, serious complications, and a high mortality, but still there is a possibility of recovery. Once the patient is able to pass a crisis, the liver is able to regenerate completely and regain its normal function. Therefore it is of vital importance to determine the eligible timing for transplantation. Premature surgery might result in a loss of the chance of internal medical treatment and misuse of liver resources, whereas delayed surgery might increase the difficulty of treatment in the preoperative period and the possibility of complications and medical expense, which eventually result in decreased rate of success and survival. This problem remains worldwide how to choose the optional timing of operation. METHODS: Thirty-six patients with severe hepatitis were treated by orthotopic liver transplantation. The distribution of MELD scores in these patients was: 10-19 in 8 patients, 20-29 in 10, 30-39 in 11, and 40 in 7. They were divided into two groups: MELD score <30 and MELD score >= 30. Parameters (1-year survival rate, complications, preoperative use of artificial liver, operative time, volume of bleeding and blood transfusion, and average hospital costs) were examined as prognostic factors after liver transplantation. RESULTS: The I-year survival rate of the MELD score <30 group was higher than that of the >= 30 group (77.8% and 33.3%, P=0.007), and the rate of complications in the <30 group was lower (P=0.012). There were no differences in the timing of artificial liver treatment, operative time, operative hemorrhage, and transfusion between the two groups (P=0.742). But the average daily hospital cost in the MELD score >= 30 group was higher (P=0.008). CONCLUSION: This study shows that when the MELD score is <30 it may be the optimal time to perform liver transplantation for patients with severe hepatitis.展开更多
Liver transplantation is indicated in patients with acute liver failure,decompensated cirrhosis,hepatocellular carcinoma and rare liver-based genetic defects that trigger damage of other organs.Early referral to a tra...Liver transplantation is indicated in patients with acute liver failure,decompensated cirrhosis,hepatocellular carcinoma and rare liver-based genetic defects that trigger damage of other organs.Early referral to a transplant center is crucial in acute liver failure due to the high mortality with medical therapy and its unpredictable evolution.Referral to a transplant center should be considered when at least one complication of cirrhosis occurs during its natural history.However,because of the shortage of organ donors and the short-term mortality after liver transplantation on one hand and the possibility of managing the complications of cirrhosis with other treatments on the other,patients are carefully selected by the transplant center to ensure that transplantation is indicated and that there are no medical,surgical and psychological contraindications.Patients approved for transplantation are placed on the transplant waiting list and prioritized according to disease severity.Thus,the appropriate timing of transplantation depends on recipient disease severity and,although this is still a matter of debate,also on donor quality.These two variables are known to determine the "transplant benefit"(i.e.,when the expected patient survival is better with,than without,transplantation) and should guide donor allocation.展开更多
目的回顾性分析20例肝移植患儿的临床资料,旨在总结儿童肝移植的临床诊治经验。方法回顾性分析2017年5月至2019年6月湖南省儿童医院联合中南大学湘雅附二医院对20例儿童实施肝脏移植手术的临床资料,原发疾病主要包括胆道闭锁、Alagille...目的回顾性分析20例肝移植患儿的临床资料,旨在总结儿童肝移植的临床诊治经验。方法回顾性分析2017年5月至2019年6月湖南省儿童医院联合中南大学湘雅附二医院对20例儿童实施肝脏移植手术的临床资料,原发疾病主要包括胆道闭锁、Alagille综合征、先天性肝内门静脉海绵样变性。手术方式采用亲体部分肝移植手术(n=16)和儿童心脏死亡器官捐献(donation after cardiac death,DCD)肝脏移植手术(n=4)。20例均应用他克莫司联合激素免疫抑制方案,其中3例增加了吗替麦考酚酯联合抗排斥反应。术后患儿给予抗感染、抗排斥等对症支持治疗,密切监测肝血管吻合处血流情况及肝功能变化,观察术后并发症及预后。结果 20例患儿均移植成功,肝移植供体均康复出院,无并发症发生。受体术后早期主要并发症为感染,以细菌感染为主,感染部位为肺部和腹腔。术后1例出现肝动脉栓塞,3例出现乳糜漏,2例出现胆道狭窄,3例出现早期排斥反应,1例出现消化道大出血,经对症治疗均痊愈出院,检测肝功能及血药浓度均在正常范围。结论儿童终末期肝病可通过活体肝移植或DCD肝移植手术取得理想的效果,手术方式可根据患儿的年龄、体重进行选择。展开更多
文摘BACKGROUND: Fulminant hepatic failure manifests a rapid onset, serious complications, and a high mortality, but still there is a possibility of recovery. Once the patient is able to pass a crisis, the liver is able to regenerate completely and regain its normal function. Therefore it is of vital importance to determine the eligible timing for transplantation. Premature surgery might result in a loss of the chance of internal medical treatment and misuse of liver resources, whereas delayed surgery might increase the difficulty of treatment in the preoperative period and the possibility of complications and medical expense, which eventually result in decreased rate of success and survival. This problem remains worldwide how to choose the optional timing of operation. METHODS: Thirty-six patients with severe hepatitis were treated by orthotopic liver transplantation. The distribution of MELD scores in these patients was: 10-19 in 8 patients, 20-29 in 10, 30-39 in 11, and 40 in 7. They were divided into two groups: MELD score <30 and MELD score >= 30. Parameters (1-year survival rate, complications, preoperative use of artificial liver, operative time, volume of bleeding and blood transfusion, and average hospital costs) were examined as prognostic factors after liver transplantation. RESULTS: The I-year survival rate of the MELD score <30 group was higher than that of the >= 30 group (77.8% and 33.3%, P=0.007), and the rate of complications in the <30 group was lower (P=0.012). There were no differences in the timing of artificial liver treatment, operative time, operative hemorrhage, and transfusion between the two groups (P=0.742). But the average daily hospital cost in the MELD score >= 30 group was higher (P=0.008). CONCLUSION: This study shows that when the MELD score is <30 it may be the optimal time to perform liver transplantation for patients with severe hepatitis.
基金Supported by The ‘‘Consorzio Interuniversitario per i Trapianti’’ and the "Fondazione Onlus Parioli"
文摘Liver transplantation is indicated in patients with acute liver failure,decompensated cirrhosis,hepatocellular carcinoma and rare liver-based genetic defects that trigger damage of other organs.Early referral to a transplant center is crucial in acute liver failure due to the high mortality with medical therapy and its unpredictable evolution.Referral to a transplant center should be considered when at least one complication of cirrhosis occurs during its natural history.However,because of the shortage of organ donors and the short-term mortality after liver transplantation on one hand and the possibility of managing the complications of cirrhosis with other treatments on the other,patients are carefully selected by the transplant center to ensure that transplantation is indicated and that there are no medical,surgical and psychological contraindications.Patients approved for transplantation are placed on the transplant waiting list and prioritized according to disease severity.Thus,the appropriate timing of transplantation depends on recipient disease severity and,although this is still a matter of debate,also on donor quality.These two variables are known to determine the "transplant benefit"(i.e.,when the expected patient survival is better with,than without,transplantation) and should guide donor allocation.
文摘目的回顾性分析20例肝移植患儿的临床资料,旨在总结儿童肝移植的临床诊治经验。方法回顾性分析2017年5月至2019年6月湖南省儿童医院联合中南大学湘雅附二医院对20例儿童实施肝脏移植手术的临床资料,原发疾病主要包括胆道闭锁、Alagille综合征、先天性肝内门静脉海绵样变性。手术方式采用亲体部分肝移植手术(n=16)和儿童心脏死亡器官捐献(donation after cardiac death,DCD)肝脏移植手术(n=4)。20例均应用他克莫司联合激素免疫抑制方案,其中3例增加了吗替麦考酚酯联合抗排斥反应。术后患儿给予抗感染、抗排斥等对症支持治疗,密切监测肝血管吻合处血流情况及肝功能变化,观察术后并发症及预后。结果 20例患儿均移植成功,肝移植供体均康复出院,无并发症发生。受体术后早期主要并发症为感染,以细菌感染为主,感染部位为肺部和腹腔。术后1例出现肝动脉栓塞,3例出现乳糜漏,2例出现胆道狭窄,3例出现早期排斥反应,1例出现消化道大出血,经对症治疗均痊愈出院,检测肝功能及血药浓度均在正常范围。结论儿童终末期肝病可通过活体肝移植或DCD肝移植手术取得理想的效果,手术方式可根据患儿的年龄、体重进行选择。
