肝移植术后长期生存:413例分析

摘要

Objective To evaluate the long-term survival outcomes of a large cohort of liver transplant recipients and to identify static and changing factors that influenced these outcomes over time. Methods 421 consecutive patients who underwent liver transplantation between May 1 1994 and March 31 2003 at our hospital, in which 413 were included in this analysis and were followed up to March 20 2008. The study population was divided into two eras based on the date of transplant. Era I : between May 1 1994 and Dec 31 2001(n=197) s Era II : between Jan 1 2002 and March 31 2003 (n=216). The effect of recipient age at the time of transplantation, recipient's gender, diagnosis, year of transplantation, kidney function, and the time during operation were compared using the Kaplan-Meier model and log-rank test. Cox regression model was used in multivariate analysis to identify prognostic factors for survival. Among the patients survival extend 5 years, the long complications were analyzed. Results The 1 year, 3 years and 5 years survival for two eras were 50.3% and 80. 9% ,40. 1% and 71. 6% , 36. 5% and 70. 0% respectively. The overall patient survival for 1 year, 3 years and 5 years were 63. 5%,56. 0% and 53. 4%, respectively. Patient survival was significantly better in younger(<55y), non-HCC(hepatin cell carcinoma) recipients, and in patients who received transplants after 2002,operation time within 12h, anhepatic phase within 1h. Cox regression model showed patient age>55, HCC recipients, Era II , operation time beyond 12h, anhepatic phase beyond 1h are the independent risk factor of long-term survival. In earlier period post-operation, the main cause of death was infection related multple organs failure, but after one year it switched to the recurrence of HCC. In advanced stage 5 years post operation, the complication of diabetes, hypertension, renal inadequacy was very high. Conclusion Significantly improved patient survival has been observed over time, contribution to the surgical technique and the administration of perioperative. The complication of diabetes, hypertension, and renal inadequacy maybe the greatest threat to long-term survival after survival 5 years.%目的 分析天津市第一中心医院早期肝移植病人的生存情况,探讨影响肝移植术后存活的危险因素,并对存活5年以上病人进行远期并发症分析.方法 回顾性分析该院1994年5月1日至2003年3月31日接受肝移植手术的病人421例,随访最后日期为2008年3月20日,适合作生存分析者413例.根据手术日期将病人分成两个时段:第一时段:1994年5月1日至2001年12月31日(n=197);第二时段:2002年1月1日至2003年3月31日(n=216).用单因素分析术前各种因素对病人生存时间的影响,用多因素回归分析影响病人存活的独立危险因索,对存活5年以上的病人分析其远期并发症发生率.结果 两个时段病人的1年、3年和5年生存率分别为:50.3%和80.9%、40.1%和71.6%、36.5%和70.0%.单因素分析显示,影响病人长期存活的因素有受者年龄、原发病是否为肝癌、手术时间长短、无肝期长短、手术时期以及术前Meld评分.Cox多因素风险回归模型分析显示影响肝移植病人远期存活的独立危险因素包括手术时期、病人年龄、原发病是否为肝癌、Meld评分、手术时间以及无肝期.病人早期死亡多因多器官功能衰竭,晚期死因多为肿瘤复发.长期存活病人糖尿病、高血压、肾功能损害等移植相关并发症的发生率较高.结论 病人术前状况、手术技术、围手术期管理、供肝保存时间均影响病人长期存活.随着手术技术的成熟,围手术期管理水平的进步,肝移植病人的长期生存率已经取得了明显的进步.对长期存活病人则应注意移植相关糖尿病、高血压、肾功能损害、新发肿瘤等并发症的监测.