单中心连续203例肝移植临床疗效分析

目的探讨进一步提高肝移植疗效的措施。方法回顾性分析复旦大学附属中山医院2001年4月至2004年10月连续203例肝移植的临床资料。肝移植患者包括肝细胞癌142例、肝炎后肝硬化36例、暴发性肝功能衰竭7例、Wilson病6例以及其他终末期肝脏疾病12例。其中,尸体供肝移植199例,包括2例减体积肝移植、1例劈裂式肝移植;活体供肝移植4例。采用Cox多元回归分析确定影响肝癌肝移植预后的危险因素。结果203例肝移植患者术后1年、2年生存率分别为85．0％和82.4％。总的排斥反应发生率为12．3％。142例肝癌肝移植患者中有20例复发(复发率14.1％),1年、2年生存率分别为80.2％和78,4％,1年、2年无瘤生存率分别为85．3％和80．3％。多元回归分析显示肿瘤直径和门静脉癌栓是影响无瘤生存率的独立预后因素。结论肝移植是我国治疗各种终末期肝脏疾病的有效手段,同时可使部分肝癌患者获得治愈或延长生命的机会。

Therapeutic effectiveness of liver transplantation: a single center study of 203 consecutive cases

OBJECTIVE: To investigate the measures to further improve the therapeutic efficacy of liver transplantation. METHODS: The clinical data of 203 consecutive cases of orthotopic liver transplantation (OLT) performed in Zhongshan Hospital, Fudan University April 2001 to October 2004, with the indications for considering OLT of hepatocellular carcinoma (HCC) (142 cases), liver cirrhosis (36 cases), fulminant hepatic failure (7 cases), Wilson's disease (6 cases), and other end-stage liver diseases (12 cases), including 199 cases of cadaveric OLT, inclusive of 2 cases of reduced-size and 1 case of splitting liver transplantation, and 4 cases of living-donor liver transplantation, were retrospectively analyzed. Multivariate analysis using Cox proportional hazards regression model was applied to determine the risk factors predicting liver transplantation prognosis for HCC. RESULTS: For the whole group of the 201 patients, the 1-year and 2-year cumulative survival rates were 85.0% and 82.4% respectively and the rejection rate was 12.3%. In the HCC group the 1- and 2-year cumulative survival rates were 80.2% and 78.4%, and the 1- and 2-year disease-free survival (DFS) rates were 85.3% and 80.3% respectively. HCC recurrence was observed in 20 patients after OLT with a recurrence rate of 14.1%. Multivariate analysis revealed that the tumor size and portal vein tumor thrombus were the most independent and statistically significant factors affecting the DFS. CONCLUSION: OLT may be the most effective treatment option for patients with end-stage liver diseases and may also provide the opportunity of curative treatment or survival improvement for selected patients with hepatic malignancies.