再次肝移植10例临床分析

目的总结再次肝移植的临床经验。方法回顾性分析我中心自2003年5月至2006年12月间实施的10例再次肝移植患者的临床资料并进行随访，对再次移植的指征、手术时机、手术方式及预后进行讨论。结果在连续实施的315例同种异体原位肝移植中共有10例接受了再次移植．再次移植率为3．17％。再次移植指征分别为胆道并发症4例（40％），原发病复发4例（40％），其中包括肝癌复发2例（20％），乙肝复发1例（10％），肝硬化复发1例（10％），移植肝原发性无功能1例（10％）．肝动脉血栓形成1例（10％）。10例患者中有3例死亡，其中2例死于全身严重的感染伴多器官功能衰竭，1例死于肝癌复发转移。其余7例患者均痊愈出院．随访至今已存活10～28月．肝功能及一般状况良好。结论合理选择再次移植的指征，把握合适的手术时机，建立完善的预后评估模型是提高再次肝移植患者存活率的关键。

Clinical analysis of liver retransplantation in 10 cases

Objective To summarize the clinical experience of liver retransplantation.Methods The clinical data and follow-up of 10 patients who underwent liver retransplantation in our department from May 2003 to Dec 2006 were retrospectively analyzed.The indications,operation time,operation method and prognosis of retransplantation were discussed.Results Among the 315 consecutive liver transplantation patients,10(3.17%) had liver retransplantation.The causes of liver retransplantation were biliary complications(4 cases),primary nonfunction(1 case),hepatic artery thrombosis(1 case),recurrent disease(4 cases),including tumor recurrence(2 cases),hepatitis B recurrence(1 case) and cirrhosis recurrence(1 case).Three patients died,of them 2 were of severe infection combined with multiple organ failure,1 was hepatocellular carcinoma recurrence.Seven patients were discharged healthy and were followed up for 10 to 28 months,respectively.Conclusion Reasonable selection of the indication,choosing the proper operation time and establishing the outcome evaluation model will contribute to increase the survival rate of the retransplantation patients.