再次肝移植22例的指征与疗效分析

目的 分析我院再次肝移植患者的手术指征和移植效果.方法 2001年6月至2004年11月,22例患者因各种原因行再次肝移植.原因分别为：胆道并发症10例,肝动脉血栓形成4例,其中1例合并胆漏,慢性排斥反应4例,急性排斥反应2例,原发性移植肝无功能2例.并对再次肝移植患者进行随访.结果 在22例再次移植患者中,存活12例,死亡10例,住院期间死亡率为45%（10/22）.死亡病例术后生存时间3～35 d,平均12.6 d.死于脓毒败血症7例;手术出血性休克2例;脑血管意外1例.在存活者中,并发症发生率为25%（3/12）,其中胆道并发症2例,伤口裂开1例,院内感染11例,感染率为92%（11/12）.随访2～28个月,中位随访时间18个月.存活3～31个月,中位生存时间为16个月.结论 再次肝移植主要指征为胆道并发症、肝动脉栓塞、慢性及急性排斥反应,原发性移植肝无功能.导致再次肝移植死亡原因主要为脓毒败血症.

The indications and outcome of liver retransplantation in 22 cases

Objective To summarize the indications and outcome of liver retransplantation in our centre. Methods Between June 2001 and Nov 2004, 22 patients underwent liver retransplantation for biliary complications (10 cases), hepatic artery thrombosis (4 cases), chronic rejection (4 cases), acute graft rejection (2 cases), primary graft dysfunction (2 cases). Results The overall postoperative mortality of liver retransplantation was 45% (10/22). The leading causes of death included sepsis in 7 patients, intraoperation bleeding in 2, cerebral hemorrhage in 1. The postoperative complication rate was 25% (3/12) including biliary complication in 2 patients, cerebrovascular accident in 1. The nosocomial infection rate in the survivors was 92% (11/12). All discharged retransplant patients were followed from 2 months to 28 months, with the average of 18 months. The median survival time was 16 months. Conclusions The main indications leading to liver retransplantation include biliary complications, hepatic artery thrombosis, chronic rejection, acute rejection and primary dysfunction. The mortality is very high. The primary cause of death is sepsis.