再次肝移植--挽救肝移植失败受体生命唯一的手段(附774例报告)

目的 评估肝移植，尤其是再次肝移植的长期随访结果及影响结果的因素。方法 对1981年2月至1998年4月期间进行的、存活时间大于2年的4000例肝移植进行随访，其中再次肝移植774例。根据首次肝移植的时间，分为A、B、C三期。结果 774例（19．4％）接受第2次肝移植，148例（3．7％）接受第3次肝移植，20例（0．5％）接受第4次肝移植，5例（0．13％）接受第5次及5次以上肝移植。第1次再移植原因主要为移植肝原发性无功能、肝动脉栓塞和排斥反应。C期再次肝移植率（13．4％）明显低于A期（33．4％）和B期（23．7％），P＝0．001。结论 掌握适当的再移植指征、再次手术时机、受体的选择和手术技巧，再次肝移植的长期生存率明显改善。

Retransplantation ? The only means to save recipient's life after failure of liver transplantation: a report of 774 cases

ObjectiveTo evaluate the long-term survival outcomes of a large cohort of liver transplant recipients, especially retransplant ones, and to identify static and changing factors influencing these outcomes over time. The study population was divided into era A, era B and era C based on the date of the first transplant. MethodsFour thousand consecutive patients who underwent liver transplantation between February 1981 and April 1998 were included in this analysis and were followed up to March 2000. There were 774 cases of retransplantation in these patients. ResultsIn the follow-up period, 774 patients (19.4%) received a second transplant, 148 (3.7%) a third transplant, 20 (0.5%) a fourth transplant and 5 (0.13%) more than four allografts. The causes of retransplantation in various eras were mainly primary nonfunction, hepatic artery thrombosis and rejection. The overall rate of retransplantation has significantly declined in each subsequent era: from 33.4% in era A to 23.7% in era B and 13.4% in era C (P=0.001). ConclusionsThe survival of retransplanted patients has been significantly promoted through selecting indications, timing of retransplantation and recipients and improving operative techniques.