再次肝移植单中心16例分析

摘要

Objective To investigate the indication,clinical outcomes and prognosis of liver retransplantation.Method The clinical data of 612 patients who underwent liver transplantation (LT)from Apr.2004 to Apr.2013 in our center were retrospectively reviewed and analyzed.Results There were 16 cases of liver retransplantation.The rate of liver retransplantation was 2.6％ (16/612).The interval of primary transplantation and retransplantation was (16.2 ± 18.3)months (10 days～64 months,median 9.5 months).The cumulative death rate after retransplantation was 50％ (8/16) and the perioperative mortality was 18.8％ (3/16).An interval of beyond 6 months between the two transplantations was helpful in reducing the perioperative mortality of liver retransplantation.The survival time of the second liver graft was (37.4±34.3)months (3 days～94 months,me dian 39.5 months),the recipients' survival time (53.6±33.9)months (10 days～94 months,median 57 months) and the 5 years survival 48.3％.Conclusions Liver retransplantation is a reasonable,necessary and feasible treatment for patients who suffered from severe complications after primary liver transplantation.Liver retransplantation carried out 6 months after primary liver transplantation had a lower perioperative mortality.%目的 研究再次肝移植术的手术适应证、临床效果和预后.方法 回顾性分析2004年4月至2013年4月我中心进行的612例肝移植临床资料.结果 共有16例再次肝移植,再次肝移植率2.61％(16/612).两次移植间隔时间(即首次移植物存活时间)为(16.2±18.3)个月(10 d至64个月,中位时间9.5个月).再次肝移植后总体病死率50％(8/16),围手术期病死率18.75％(3/16);再次移植物存活时间为(37.4±34.3)个月(3d至94个月,中位时间39.5个月)；受者平均生存时间(53.6±33.9)个月(10 d至94个月,中位时间57个月),5年总体生存率48.3％.结论 对于肝移植术后常规方法难以治疗的严重并发症,再次肝移植是合理、必要和可行的救治手段.再次肝移植在首次移植6个月后进行,有利于降低再次肝移植的围手术期病死率.