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目的 探讨急诊成人右半肝活体肝移植治疗重型肝炎的疗效。方法 2002年9月至2005年8月期间共施行急诊成人右半肝活体肝移植治疗重型肝炎患者9例,回顾性分析所有患者的临床和随访资料。结果 9例患者术前肝功能均为Child C级,MELD评分为26.74-8.8,术前主要并发症为肝性脑病5例,严重电解质紊乱3例,肾功能衰竭2例,消化道出血1例。供、受者手术均顺利。术后主要并发症:急性肾功能衰竭3例,肺部感染2例,肝移植相关性脑病1例。未出现原发性肝脏无功能及血管、胆道系统并发症。1年生存率为55.6%。全组供者未出现严重并发症及死亡。结论 急诊成人活体肝移植治疗重症乙型肝炎可明显提高患者生存率,供者术前评估必须充分以确保安全。 相似文献
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Dialysis in non-renal organ (liver) transplantation 总被引:4,自引:0,他引:4
Richardson D 《Nephron》2001,88(4):296-306
The renal management of acute hepatic failure and liver transplantation requires an understanding of the features of liver failure and the causes of liver graft dysfunction. The management of any underlying pathology in addition to supportive care is fundamental to successful management and a return to independent renal function. These issues are discussed particularly in relationship to a case history involving a patient presenting with acute fulminant liver failure secondary to a paracetamol overdose who was successfully treated by liver transplantation and continuous veno-venous haemodiafiltration. The liver can be successfully transplanted but acute renal failure is a severe complication post-transplantation. Its appearance can be predicted in patients with pre-transplant renal dysfunction, severe graft dysfunction, or both. It may be avoided through careful selection of transplant recipients and correct timing of transplantation. Prevention of renal failure, appropriate patient selection for transplantation and timely procurement of a donor organ are vital for best use of limited donor resources. Treatment success depends on patient and donor selection, skilled surgeons, careful post-operative care, and successful immunosuppression. 相似文献
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肾移植176例死亡分析 总被引:9,自引:0,他引:9
目的:分析探讨肾移植受者的死亡情况和死亡在因。方法:总结1977年10月至1999年6月1039例尸体肾移植患者的临床资料。术后患者死亡率的计算按Kaplan-Meier乘积极限法进行。对可能影响移植受者死亡的因素,加供受者性别和年龄、移植次数、移植前透析时间、移植前输血量、淋巴细胞毒交叉试验、冷缺血时间、肾功能延迟恢复、急慢性排斥反应、免疫抑制药物治疗以及术后并发症等因素进行log-rank单因素和Cox模型多因素分析。结果:截至1999年12月,1039例中存活863例,死亡176例。总的术后1、5、10及15年累计死亡率分别为6.9%、19.7%、32.1%和34.7%,感染、心脑血管疾病和肝功能衰竭分别占38.1%、21.6%和14.8%。在全部死亡病例中,移植肾有功能者占75.0%,而移植后1年以上的死亡患者中移植物有功能者占87.5%。对可能影响患者死亡的诸多变量进行单因素和多因素的综合分析显示:移植年代、移植前透析时间、免疫抑制药物治疗、慢性排斥反应、术后肺炎以及心脑血管疾病并发症等6个因素与肾移植术后患者的死亡相关(P<0.001)。结论:移植1年后患者死亡率以平均每年2.5%的速度递增。感染、心脑血管疾病和肝功能衰竭是引起死亡的3个主要原因。接受移植的年代、移植前透析时间、免疫抑制药物治疗、慢性排斥反应、术后肺炎以及心脑血管疾病并发症等是肾移植受者死亡的重要影响因素。 相似文献
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【摘要】 目的 探讨脑死亡器官移植供体在ICU的维护要点。方法〓回顾性分析我科2012年1月~2013年12月间完成的29例脑死亡供体器官捐献资料,分析脑死亡供体器官获取前情况,移植肾、移植肝受者情况及急性肾损伤(AKI)供肾的移植效果,总结脑死亡患者作为潜在供体的维护要点。结果〓维护脑死亡供体29例,共捐献肾脏40个、肝脏27个、心脏4个、角膜21对。6例(15%)移植肾受者发生移植物功能延迟恢复,1例(2.5%)发生急性排斥反应、1例(2.5%)发生髂内动脉假性动脉瘤出血切除移植肾,1例(2.5%)发生重症肺炎术后死亡;AKI供肾与非AKI供肾的受者在术后7天、2月肌酐恢复情况及不良事件发生率比较无明显差异;1例(4%)移植肝受者发生多脏器功能衰竭术后死亡。余受者随访至今均恢复顺利,器官功能良好。结论〓经过ICU内积极管理后的潜在器官移植供体能够获得较高质量的移植器官,有较好的移植效果。 相似文献
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Roberto S. N. Kalil Sharon L. Hudson Robert S. Gaston 《American journal of transplantation》2003,3(1):79-81
Death with a functioning graft (DWF) is now the most common cause of late renal transplant failure, with cardiovascular disease its most frequent etiology. In some populations, infection with cytomegalovirus (CMV) increases risk of coronary disease. Few data exist regarding CMV and cardiovascular mortality after renal transplantation. We reviewed charts of 158 adult patients who died more than 90 days after receiving renal allografts and a matched cohort of 143 (of 2398) surviving patients transplanted at the University of Alabama at Birmingham between 1990 and 1998. Only advancing donor and recipient age increased risk of DWF; CMV infection did not. However, of 50 patients who died of cardiovascular causes, 94% were seropositive for CMV, while only 74% of the other 108 deaths occurred in CMV-seropositive patients (p < 0.05). Risk of cardiovascular death was greatest (p < 0.05) in patients with diabetes, advancing age, and CMV seropositivity. In renal transplant recipients, infection with CMV increases risk of death as a result of cardiovascular causes. 相似文献
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K. D. S. Watt R. A. Pedersen W. K. Kremers J. K. Heimbach M. R. Charlton 《American journal of transplantation》2010,10(6):1420-1427
Although mortality rates following liver transplantation (LT) are well described, there is a lack of detailed, prospective studies determining patterns of and risk factors for long‐term mortality. We analyzed the multicenter, prospectively obtained The National Institute of Diabetes and Digestive and Kidney Diseases LT Database of 798 transplant recipients from 1990 to 1994 (follow‐up 2003). Overall, 327 recipients died. Causes of death >1 year: 28% hepatic, 22% malignancy, 11% cardiovascular, 9% infection, 6% renal failure. Renal‐related death increased dramatically over time. Risk factors for death >1 year (univariate): male gender, age/decade, pre‐LT diabetes, post‐LT diabetes, post‐LT hypertension, post‐LT renal insufficiency, retransplantation >1 year, pre‐LT malignancy, alcoholic disease (ALD) and metabolic liver disease, with similar risks noted for death >5 years. Hepatitis C, retransplantation, post‐LT diabetes, hypertension and renal insufficiency were significant risk factors for liver‐related death. Cardiac deaths associated with age, male gender, ALD, cryptogenic disease, pre‐LT hypertension and post‐LT renal insufficiency. In summary, the leading causes of late deaths after transplant were graft failure, malignancy, cardiovascular disease and renal failure. Older age, diabetes and renal insufficiency identified patients at highest risk of poor survival overall. Diligent management of modifiable post‐LT factors including diabetes, hypertension and renal insufficiency may impact long‐term mortality. 相似文献
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儿童肾移植46例报道 总被引:1,自引:0,他引:1
目的探讨儿童肾移植的手术特点、术后并发症及免疫抑制治疗方案。方法回顾性研究1998年2月至2004年12月46例儿童肾移植患者的临床资料。观察受者及移植肾存活情况,受者生长发育情况及术后并发症。结果46例儿童肾移植后发生急性排斥反应10例,肾功能延迟恢复4例,尿漏1例,肝功能损害8例,肺部感染8例,全骨髓抑制3例,粒细胞减少2例,输尿管坏死1例,移植肾动脉狭窄1例。术后4周所有患者肾功能均恢复正常。术后1年人和移植肾存活率均为100%,3年人和移植肾存活率分别为100%和97.4%。结论肾移植是治疗儿童终末期肾病的有效手段。儿童肾移植术后急性排斥发生率高,免疫抑制治疗应根据不同个体的特点制定不同的方案。 相似文献
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乙、丙型肝炎病毒感染对肾移植患者长期存活的影响 总被引:6,自引:4,他引:2
目的 了解乙型肝炎病毒(HBV) 及丙型肝炎病毒(HCV) 感染对肾移植患者长期存活的影响。方法 对80 例感染HBV、HCV 者肾移植术后肝病及排斥的发生情况、死亡原因及长期存活率进行分析。结果 移植后慢性肝病发生率为21 .25% , 死亡率为18 .75 % , 显著高于非感染组(1 .19 % , P< 0.01) ;HCV 组超急性排斥及加速性排斥的发生率(6 .06% ,9 .09 % ) 显著高于非感染组(0 .72 % ,2 .74 % ; P< 0 .01 , P< 0 .05)。结论 HBV及HCV感染显著影响肾移植受者的长期存活率; 移植后肝病及感染是其主要死因; 对HBV 及HCV 感染患者应采取合理的免疫抑制治疗。 相似文献