再次肝移植临床分析

目的总结再次肝移植的病因、预后及手术方式。方法回顾性分析天津市第一中心医院1999年1月至2005年12月实施的101例再次肝移植的病因、术前MELD评分、与首次肝移植的时间间隔、手术术式选择、1年生存率、围手术期死亡的主要原因。结果再次肝移植1年的生存率为71．6％;再次移植的主要原因是胆道并发症（45、5％）;MELD值≤20的病例1年生存率（83．8％）明显高于MELD值为20—30和〉30的病例（57．1％和66．7％）;首次移植术后超过1个月再次移植围手术期生存率（83．8％）明显高于首次移植术后8—30d接受再次移植患者（41．7％）;围手术期死亡的主要原因是感染（54．2％）。结论选择合适的手术时机,根据术中情况决定具体术式,积极有效的抗感染治疗是提高再次肝移植生存率的关键。

Clinical study of liver re-transplantation

OBJECTIVE: To report experiences of liver re-transplantation. METHODS: The cause of re-transplantation, the pre-operative MELD score, timing of re-transplantation, technical considerations, 1 year survival rate and the causes of death of the patients receiving liver re-transplantation in First Central Hospital of Tianjin between January 1999 and December 2005 were retrospectively analyzed. RESULTS: One year survival rate of re-transplantation was 71.6%. The most common cause of hepatic graft failure and subsequent re-transplantation was biliary complications (45.5%). The 1 year survival rate of patients with a MELD score less than 20 was higher than patients with a score of 20 approximately 30 and > 30 (83.8% versus 57.1% and 66.7%). The peri-operative survival rate of patients who received re-transplantation 30 days after the initial transplantation was higher than those who received re-transplantation between 8 to 30 days post the first operation (83.8% versus 41.7%). The main cause of peri-operative death was celiac infections (accounted for 54.2% deaths) in the patients. CONCLUSIONS: Proper indication selection, optimum operation time, right surgical procedure, intensified peri-operative monitoring and infection control are all crucial for the improvement of survival rate in patients receiving liver re-transplantation.