肝移植术后肝动脉并发症的再次肝移植治疗

目的 探讨再次肝移植治疗肝移植术后肝动脉并发症的可行性及手术时机.方法 回顾性分析2003年12月至2006年12月收治的13例肝动脉并发症患者再次肝移植的临床资料.结果 再次肝移植的无肝期、手术时间和首次移植比较差异无统计学意义(P=0.291,P=0.312),术中出血量、ICU停留时间和首次移植比较差异有统计学意义[(3.1±1.1)L比(1.5±0.9)L(P=0.005),(4.3±1.8)d比(3.2±2.5)d(P=0.015)].围手术期病死率为38.5%(5/13),其中移植间隔1个月内死亡1例(1/4),超过1个月死亡4例(4/9).死亡原因分别为急性肾功能衰竭2例、严重感染2例、心肌梗死1例.8例存活,随访6～51个月,中位生存时间22.5个月.结论 再次肝移植是治疗肝移植术后肝动脉并发症导致不可逆性肝功能损害时的惟一有效手段.选择适宜的手术时机和手术方式、调整免疫抑制方案、加强围手术期管理是提高再次肝移植疗效的关键.

Retransplantation for hepatic artery complications after orthotopic liver transplantation

Objective To evaluate the efficacy and timing of retransplantation for hepatic artery complications after orthotopic liver transplantation.Methods Between December 2003 and December 2006, the clinical data of 13 patients diagnosed as hepatic artery complications after liver transplantation were retrospectively analyzed.Results There were no significant difference in duration of operation and anhepatic phase between the initial transplantation and the second transplantation( P = 0.291 ,P = 0.312).However, intra-operative blood loss [ (3.1±1.1 ) L vs.( 1.5±0.9) L, P = 0.005 ] and intensive care unit stays [ (4.3±1.8) d vs.(3.2±2.5) d,P =0.015] were significantly increased in the retransplant patients.No perioperative mortality occurred.The postoperative mortality of liver retransplantation was 38.5% ( 5/13 ) including acute renal failure in two patients,severe infection in two and heart infarction in one.The other 8 patients were followed from 6 months to 51 months, with a median survival time of 22.5 months.Conclusions Liver retransplantation is the only viable option for patients with irreversible graft dysfunction secondary to hepatic artery complications after liver transplantation. Proper indication and optimum time of ratransplantation ,reasonable individual immunosuppression regime and effective perioperative care program contribute to the increase of the survival rate of the patients performed liver retransplantation.