肝移植治疗终末期自身免疫性肝病的预后分析

目的  探讨肝移植治疗终末期自身免疫性肝病(AILD)的预后情况。方法  回顾性分析1996年5月至2013年4月在第二军医大学附属长征医院实施原位肝移植术的48例终末期AILD受者的临床资料。计算受者的术后累积生存率,分析死亡病例的死因,了解术后排斥反应、病毒性肝炎新发感染及AILD复发情况。结果  48例AILD受者中,存活38例,AILD受者术后5年累积生存率为76%。10例死亡受者的死亡原因包括多器官功能衰竭、移植肝衰竭、脓毒症、肺部感染、出血、肝动脉栓塞、肾衰竭。48例AILD受者中,肝移植术后发生急性排斥反应者9例(19%),有3例分别在术后1~2年内新发乙型肝炎病毒感染,有2例原发性胆汁性肝硬化受者于术后2年出现原发病复发,经积极治疗均长期生存。结论  终末期AILD肝移植受者多数可获得长期生存,应重视肝移植术后早期免疫抑制方案的制定,预防感染及排斥反应和术后新发病毒性肝炎,及时发现原发病复发等问题。

Prognostic analysis of liver transplantation in treating patients with end-stage autoimmune liver disease

Objective To investigate the prognosis of patients underwent liver transplantation （LT） for end-stage autoimmune liver disease （AILD）. Methods Clinical data of 48 patients with end-stage AILD undergoing LT from May 1996 to April 2013 in Affiliated Changzheng Hospital of the Second Military Medical University were analyzed retrospectively. The postoperative cumulative survival rates of the recipients were calculated,and the cause of death was analyzed. The postoperative rejections,new-onset viral hepatitis and AILD recurrence were analyzed. Results In 48 AILD recipients,38 cases survived and the postoperative 5-year cumulative survival rate was 76%. Causes of death for the 10 dead cases were multiple organ failure, liver graft failure,sepsis,pulmonary infection,hemorrhage,hepatic artery embolization and renal failure. In 48 AILD recipients,9 cases （19%） suffered acute rejection after operation,3 cases suffered new-onset hepatitis B infection in 1-2 years after operation,2 recipients suffered primary disease （primary biliary cirrhosis）recurrence 2 years after operation and all survived for a long term after positive treatments.Conclusions Most liver transplant recipients with end-stage AILD can obtain a long-term survival. Attentions should be paid on the immunosuppressive regimens in early period after LT,prevention of infection,rejection and postoperative new-onset viral hepatitis,timely diagnosis of primary disease recurrence.