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目的 探讨和总结临床活估肝移植的手术经验。方法 对12例活体肝移植（13次手术，包括第一次减体积再次肝移植手术）的手术情况进行回顾性分析。结果 13次活体肝移植手术均获成功；所有供体手术后顺利康复，未出现任何严重并发症，并全部纳入术后长期随访中。1例晚期肝癌病人移植后死于胆瘘及继发多器官功能不全；9例Wilson病受体获得长期存活，术后神经系统症状显著改善，复查肝功能、铜氧化酶水平全部在正常范围；1例Wilson瘤，受体于术后72天死于不可递转的排异反应；1例乙型肝炎肝硬化伴亚急性戊型肝炎、肝功能衰竭、Ⅳ期肝性脑病的病人，行急诊成人右叶供肝活体肝移植，术后恢复顺利，现为术后第11周，未出现严重并发症，已恢复正常生活。结论 精湛细致的手术技术是活体肝移植成功的关键，活体肝移植适合我国国情，是解决当前全球性供肝来源匮乏问题的有效途径。     

活体肝移植受者的外科并发症防治

目的：探讨活体肝移植受者术后外科并发症的防治方法。方法：回顾性分析18例活体供肝原位部分肝移植受者的临床资料。结果术后发生肝动脉栓塞2例(11.1％)，其中1例手术取栓失败，2例均接受再次肝移植，获得成功；门静脉栓塞1例(5．6％)，手术取栓失败，患者死亡；胆漏2例(11．1％)，经置管引流、抗感染治疗后痊愈；无流出道梗阻及胆道狭窄发生。住院期间死亡2例，分别死于多器官功能衰竭、门静脉栓塞。结论：活体原位部分肝移植后的外科并发症重在预防，供肝的采取、修整以及手术技术是关键。     

同种原位肝移植围手术期的处理

目的 总结我院自1999年8月以来，开展的3种同种异体原位肝移植（Orthotopic liver transplantation,OLT)围手术期的处理过程及经验体会。方法 2例原位肝移植，1例肝-肾联合移植术。均在术前12h口服环孢霉素A（CsA)和骁翻（MAP），术中用甲基强的松龙（MP）1000mg静脉冲击防止排斥，术后MP CsA MAP三联用药。结果 （1）中3你病人手术均获成功，其中2例原位肝移植病人存活至今，生活质量良好。肝肾联合移植病人于术后第76d死于严重混合感染。（2）移植肝的功能维护是肝移植术后处理的重点，其中包括急性排斥反应的诊断和处理，以及其它可能引起肝移植肝功能损害，衰竭等问题的处理。（3）全身非移植器官的功能恢复；包括呼吸系统，感染，出血，胸水，腹水等并发症处理过程。结论 肝移植围手术期的处理是肝移植成功与否的关键，其中包括肝移植的排斥反应及各系统的功能支持与维护。     

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.     

肝移植术后严重感染状态下的严重排斥反应3例报告

回顾性分析收治的3例肝移植患者在严重感染状态下免疫抑制治疗的临床资料。结果示1例活体辅助肝移植患者几乎完全停用免疫抑制剂后发生严重排斥反应导致移植肝丧失；1例老年肝移植患者免疫抑制剂减量后出现严重排斥反应，立即予激素冲击治疗获良好效果；1例患者大幅减少免疫抑制剂后发生严重排斥反应，导致门静脉血栓形成而被迫再次肝移植。提示肝移植术后严重感染状态下行免疫抑制剂减量或停用时须密切观察是否发生急性排斥反应；一旦发生，宜果断予加强免疫抑制剂治疗。     

成人活体肝移植后再次肝移植六例

目的总结成人活体肝移植后再次肝移植的体会。方法6例曾经接受活体肝移植者因胆道并发症（2例）、血管并发症（2例）、慢性排斥反应（1例）和肝炎复发（1例）而接受再次肝移植，再次肝移植均采用改良背驮式原位肝移植术。除1例将供肝动脉改为与受者腹主动脉吻合外，其余均为同名血管的端端吻合。结果1例术后因原发性移植肝无功能死亡；1例肝动脉吻合口狭窄，经介入治疗放置支架后缓解。随访至今，5例已分别存活12、9、6、4和3个月，目前肝功能良好。结论腹腔内粘连是成人活体肝移植后再次肝移植的手术难点。     

自体肝移植术中和术后并发症及其防治

目的 探讨自体肝移植术中、术后并发症及防治方法.方法 回顾性分析2005年10月至2011年12月本中心完成的36例自体肝移植术.其中恶性肿瘤患者23例,良性疾病患者13例.总结术中、术后并发症及其处理方法.结果 本组患者术后并发症包括胆瘘、小肝综合征、出血、肺水肿及肺部感染等.术中严重并发症包括2例心跳骤停.2例在术后并发小肝综合征,其中1例发生急性肝功能衰竭,改行异体肝移植,2例均安全度过围手术期并顺利出院.36例患者自体肝移植术后1、2、3年生存率分别为75％、71％、68％.其中恶性肿瘤患者自体肝移植术后1、2、3年生存率分别为65％、59％、54％.结论 通过完善的术前评估,可降低自体肝移植患者术后肝功能衰竭等严重并发症的发生率.术中、术后及时预防和处理严重并发症,可降低围手术期病死率,为自体肝移植患者的长期存活提供保障.     

背驮式肝移植肝脏流出道重建方法探讨

目的：总结我院肝移植时肝流出道重建的经验。方法：回顾性分析我院50例肝移植时肝流出道重建方法的改进及效果。结果：本组肝移植病例围手术期死亡8例，围手术期死亡率为16％。本组并发症为：肺部感染32例：多器官功能衰竭2例；腹腔内出血2例；肝动脉血栓形成1例；胆漏2例；无肝脏流出道梗阻。2例生存超过3年，8例生存超过2年，18例生存超过1年。结论：肝流出道重建方法的改进有利于提高肝移植的成功率，减少技术性并发症。     

肝移植术后胆道并发症的危险因素分析

目的 探讨肝移植术后胆道并发症的临床特点及危险因素.方法 回顾性分析施行的172例肝移植患者的临床资料.选取围手术期45个独立变量进行单因素分析及Logistic回归分析,筛选出与肝移植术后胆道并发症相关的危险因素.结果 32例发生胆道并发症,患病率为18.6%,包括10例胆瘘,14例无胆瘘的胆管狭窄,5例无胆瘘或胆管狭窄的胆道结石,2例单纯胆道感染,1例单纯胆道出血.其发生的中位时间为22(3～585 d)d.Logistic回归分析显示急性排斥反应(P＜0.001),慢性排斥反应(P=0.030),留置T管(P=0.005),术后1个月的肝动脉阻力指数(RI)≤0.66(P=0.026)是术后胆道并发症的独立危险因素.结论 肝动脉血流动力学的严密监测、必要的预防性抗凝治疗、规范的抗排斥治疗、不留置T管的胆管重建方式有助于降低胆道并发症发生率.     

活体供肝肝移植成功的初步经验--附3例报告

目的 报告3例活体供肝肝移植成功的初步经验。方法 回顾性分析1例肝细胞癌伴肝硬化、1例先天性肝内胆汁淤积症及1例药物性肝炎病人活体供肝肝移植经过和供受体恢复情况。结果 供肝均取自病人父亲，1例为右半肝，另2例为扩大左外叶，供肝重量分别为835g、295g及320g。第1例供体术后有一过性黄疸，且有轻度胆漏，另2例供体术后恢复顺利，无手术并发症。3例病人手术均顺利，1例成人一成人活体供肝肝移植胆道重建为胆管端端吻合，术后定期行全身化疗预防肿瘤复发。2例成人-儿童活体供肝肝移植胆道重建为胆管、空肠Roux-en-Y吻合。3例病人均行肝静脉整形以保证静脉回流通畅。随访至今，供受体已分别健康生存16、14、13个月。结论 严格的病例选择，完善的术前准备，精细的手术操作及正确的术后处理是活体供肝肝移植成功的关键。     

Living Related Liver Transplantation in Adults: First Year Experience at the University of Liège

Living related liver transplantation (LRLT) in adult recipients has been recently developed to overcome the organ donor shortage, but LRLT leaves the healthy donors at risk of serious post-operative complications, or even death. The aim of this paper is to report the prospective evaluation of the initial experience of adult LRLT at the University of Liège. From March 2002 till March 2003, in a consecutive series of 35 adult liver transplantations, five recipients (mean age: 51 years) underwent LRLT, including one retransplantation. Indications for transplantation were autoimmune hepatitis, hepatitis B virus related cirrhosis with hepatocarcinoma (two cases), hepatitis C virus related cirrhosis with hepatocarcinoma, and ischemic intrahepatic bile duct necrosis 10 years after primary liver transplantation. Mean age of the donors was 34 years (range: 21-53 years). All donation cases were intra familial at first degree. The right lobe was used as a graft in four cases and the left lobe in one case. All right lobe donors developed transient hyperbilirubinemia and hypocoagulation for 4 to 6 days. No severe complication (transfusion, bile duct fistula, reintervention, rehospital-ization) nor significant long-term sequelae were observed in the donors. In the recipients, graft function was immediate, and there was no small-for-size syndrome. One recipient developed biliary fistula treated by reoperation. One recipient died from invasive aspergillosis 11 days after the procedure. The four other recipients were alive without recurrence of the disease at follow-up. This report confirmed that LRLT may be a valuable alternative to cadaveric liver transplantation in the era of organ donor shortage. However, even if there was no severe complication for the donors in our preliminary experience, LRLT puts healthy living donors at risk of significant morbidity and even death.     

Living related liver transplantation in adults: first year experience at the University of Liège

Living related liver transplantation (LRLT) in adult recipients has been recently developed to overcome the organ donor shortage, but LRLT leaves the healthy donors at risk of serious post-operative complications, or even death. The aim of this paper is to report the prospective evaluation of the initial experience of adult LRLT at the University of Liège. From March 2002 till March 2003, in a consecutive series of 35 adult liver transplantations, five recipients (mean age: 51 years) underwent LRLT, including one retransplantation. Indications for transplantation were autoimmune hepatitis, hepatitis B virus related cirrhosis with hepatocarcinoma (two cases), hepatitis C virus related cirrhosis with hepatocarcinoma, and ischemic intrahepatic bile duct necrosis 10 years after primary liver transplantation. Mean age of the donors was 34 years (range: 21-53 years). All donation cases were intra familial at first degree. The right lobe was used as a graft in four cases and the left lobe in one case. All right lobe donors developed transient hyperbilirubinemia and hypocoagulation for 4 to 6 days. No severe complication (transfusion, bile duct fistula, reintervention, rehospitalization) nor significant long-term sequelae were observed in the donors. In the recipients, graft function was immediate, and there was no small-for-size syndrome. One recipient developed biliary fistula treated by reoperation. One recipient died from invasive aspergillosis 11 days after the procedure. The four other recipients were alive without recurrence of the disease at follow-up. This report confirmed that LRLT may be a valuable alternative to cadaveric liver transplantation in the era of organ donor shortage. However, even if there was no severe complication for the donors in our preliminary experience, LRLT puts healthy living donors at risk of significant morbidity and even death.     

Living-related liver transplantation in children at Saint-Luc University Clinics: a seven year experience in 77 recipients

The Brussels series of living related liver transplantation (LRLT) in 77 children (< 15 years) is reviewed. Median (range) recipient age at liver transplantation was 1.1 year (0.4-13.1). The main indication for LT was biliary atresia in 55/77 cases (71%). The living-related donor was one of the parents in 74 instances. Hepatic segments 2-3 (n = 67) or 2-3-4 (n = 10) were implanted orthotopically, with a median (range) graft weight to recipient body weight ratio of 3.17% (0.91-8.08). No severe complications or significant long-term sequelae were encountered in the living donors. One and five year survival rates were 92% and 89% for the patients, and 90% and 86% for the grafts, respectively. The retransplantation rate was 2/77 (2.6%), the indication being chronic rejection in both instances. In conclusion, LRLT is now a validated procedure in the living donors as well as in pediatric recipients with chronic or acute liver diseases. In the current context of organ shortage, it provides a valuable alternative to cadaveric LT.     

Long-term results of living-related donor liver graft transplantation: a single-center analysis of 110 transplants

BACKGROUND: Difficulties of cadaveric donation and serious donor shortage have led to the development and popularization of living-related donor liver graft transplantation (LRLT). Because the history of this procedure is rather short, important aspects specific to this procedure have not been sufficiently documented. The objective of this study was to analyze a single center's 10-year experience with 110 LRLT in pediatric and adult patients with end-stage liver diseases. METHODS: The medical records of 110 consecutive patients who underwent LRLT were reviewed. The recipients were comprised of 72 children and 38 adults. The graft volume corresponded to 26-192% of the recipient's standard liver volume. The relationship between pretransplant covariates and patient and graft survival was analyzed. Actuarial patient/graft survival rates were determined at 1, 3, and 5 years. The type and incidence of posttransplant complications were analyzed, as was long-term graft function. RESULTS: The 1-, 3-, and 5-year actuarial patient and graft survival rates were 88%, 85%, and 85%, respectively. Log-rank test demonstrated that ABO-compatibility predicted patient survival rate, whereas patient age, underlying disease, patient's clinical status, donor-recipient relation, donor age, and graft volume/standard liver volume ratio did not. Long-term liver function remains excellent. All the donors have returned to normal daily lives with an uneventful course. CONCLUSIONS: LRLT is an efficacious procedure that provides excellent short-term and long-term survival. The indication criteria for both recipient and donor were legitimate in this series, except for transplant across ABO-incompatibility. Cautious expansion of this procedure may be justified under the situation of serious shortage of cadaveric donor.     

Right lateral sector graft in adult living-related liver transplantation.

BACKGROUND: A major concern regarding adult living-related liver transplantation (LRLT) is graft-size disparity. The authors report their experience with LRLT using the right lateral sector. PATIENTS AND METHODS: Between January 2000 and April 2001, 32 adult-to-adult LRLTs were performed at our institution. Of these, six patients received a right lateral sector (RLS, segments VI and VII according to Couinaud's nomenclature for liver segmentation) graft. The right liver was over 70% of the estimated volume of the whole donor liver. The estimated RLS volume was greater than that of the left liver, which was over 40% of the recipient's standard liver volume. RESULTS: The postoperative course was uneventful in all donors. All of the patients survived the operation. Three patients were complicated with bile leakage from the dissection plane of the graft. Four patients suffered from acute rejection. CONCLUSIONS: RLS graft obtained by this procedure may be useful for overcoming borderline graft-recipient size differences and expanding the donor pool.     

Donor Factors Predicting Recipient Survival After Liver Retransplantation: The Retransplant Donor Risk Index

The use of extended criteria liver donors (ECD) is controversial, especially in the setting of retransplantation. The aims of this study are to investigate the effects of ECD grafts on retransplantation and to develop a predictive mortality index in liver retransplantation based on the previously established donor risk index. The United Network for Organ Sharing (UNOS) liver transplant dataset was analyzed for all adult, non-status 1, liver retransplantations occurring in the United States since February 2002. All donors were categorized for multiple characteristics of ECD, and using multivariate survival models a retransplant donor risk index (ReTxDRI) was developed. A total of 1327 retransplants were analyzed. There were 611 (46%) recipients who received livers with at least one ECD criterion. The use of ECD grafts in recipients with HCV did not incur worse survival than the non-ECD grafts. The addition of the cause of recipient graft failure to the donor risk index formed the ReTxDRI. After adjusting for multiple recipient factors, the ReTxDRI was predictive of overall recipient survival and was a strongly independent predictor of death after retransplantation (HR 2.49, 95% CI 1.89–3.27, p < 0.0001). The use of the ReTxDRI can improve recipient and donor matching and help to optimize posttransplant survival in liver retransplantation.     

Living related liver transplantation across ABO blood groups with FK506 and OKT3

In living related liver transplantation (LRLT), the use of graft livers across ABO blood groups is unavoidable since the organ donor is usually one of the recipient's parents. This report presents our initial experiences with LRLT, focusing on ABO-incompatible cases. From June 1990 to May 1992, we successfully performed a series of 34 LRLT on children (15 males and 19 females) ranging in age from 7 months to 15 years. Overall recipient survival rates were 90% (25/28) in elective LRLT and 50% (3/6) in emergency LRLT. These cases were classified into three groups: ABO blood group-identical (n=21), compatible (n=10), and incompatible (n=3). The immunosuppressive regimen consisted of FK506 and low-dose steroids in the first two groups. In the incompatible cases, exchange transfusion was performed to decrease anti-A and/or-B antibody titers before LRLT, and prophylactic OKT3 was added to FK506 and steroids after LRLT. No significant difference in recipient and graft survifal was observed among the groups. In the identical group, no rejection episodes have been observed thus far. Rejection occurred in two out of the ten compatible cases. Among the incompatible cases, one recipient had mild rejection and was treated. The remaining two recipients have had no rejection episodes thus far. Although all three recipients had cytomegalovitus (CMV) infection, they were successfully treated with gancyclovir, and no lethal infection has developed in any of these cases. The present results suggest that graft livers from living related donors across ABO blood groups can function well with FK506, low-dose steroids, and prophylactic OKT3 without causing lethal complications.     

Twenty cases of adult-to-adult living-related liver transplantation: single-center experience in Saudi Arabia

BACKGROUND: The deceased donor organ shortage has forced surgeons to implement innovations, including living-related liver transplantation (LRLT). OBJECTIVE: To present the first 20 cases of adult LRLT in a single center in Saudi Arabia. METHODS: From November 2000 to May 2004, we performed 20 cases of LRLT. Eighteen donors were men and 2 were women. Their median age was 27 years. Seventeen of the recipients were men and 3 were women of median age 55 years. One patient received combined liver and kidney grafts. RESULTS: All cases had liver cirrhosis. Seven had hepatitis C; six, hepatitis B and C; three, hepatitis B; one, alcoholic cirrhosis; one, Bylar disease, one hepatic schistosomiasis, and one cryptogenic cirrhosis. Three cases had associated hepatocellular carcinomas. There was no donor mortality. In the recipients, the overall patient and graft survival was 85%. While 10 donors presented uneventful postoperative courses, 8 experienced minor complications and 2, major complications: biliary stricture and portal vein thrombosis. Recipients complications included biliary complications (35%), acute rejection (20%), hepatitis C reactivation (20%), hepatic vein stenosis (10%), hepatic artery stenosis (5%), and hepatocellular carcinoma recurrence (5%). CONCLUSIONS: LRLT has become a standard option in adults with end-stage liver failure in our center.