十五年来再次肝移植的发展趋势和经验教训
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标题：十五年来再次肝移植的发展趋势和经验教训
作者：fitzmann R，Benscheidt B，Langrehr JM，Schumacher G，Neuhaus R，Neuhaus P。
消息来源：《肝移植》杂志。2007年2月。刊号：13（2）：248-57。
影响因子：4.225（2005）
与首次肝移植（LT）相比，再次肝移植（re-LT）的疗效不佳仍是主要问题。本研究的目的是分析Charite Virchow诊所15年间再次肝移植（re-LT）患者的变化与预后。1989到2003年间，我们共为1462位患者完成了1619例肝移植，其中157例是再次肝移植。我们共分析了119位再次肝移植患者（女性50位，男性69位），应用的排除标准包括：患者年龄小于16岁、第三次肝移植、首次肝移植为劈裂式肝移植或活体肝移植、肝肾联合移植或者肝移植联合Whipple手术。所有的患者都接受全肝再移植。平均随访时间为62个月（6天到187个月不等）。再次肝移植的主要适应症包括原发性失功（26.9%）、肝炎病毒复发（20.2%）、肝动脉的急、慢性排斥及肝动脉血栓形成（各占16.8%）。患者死亡的主要原因为细菌感染（26.0%）、术后一个月内的出血和疾病复发（后两者都为16%）。总得来说，119位患者中，50位（42%）死于re-LT术后，26位在3个月内死亡，38位在1年内死亡。所有患者的一个月生存率为89.9%，一年生存率为78.2%，五年生存率为67.1%。结论，研究证明re-LT术后的临床效果好。但早期器官衰竭和肝动脉血栓形成增多，分析同样也指出了排异、缺血型胆道病变等并发症在减少。基础疾病复发率15年来一直保持稳定。
Title:Trends and experiences in liver retransplantation over 15 years.
Author:Pfitzmann R, Benscheidt B, Langrehr JM, Schumacher G, Neuhaus R, Neuhaus P.
Source:Liver Transpl. 2007 Feb;13(2):248-57.
IF:4.225(2005)
Compared to primary liver transplantation (LT), the inferior results in the outcome of liver retransplantation (re-LT) continue to be a major challenge. The purpose of this study was to analyze changes in and outcomes of re-LT over a period of 15 years at the Charite Virchow Clinic. Between 1989 and 2003, we performed 1,619 LTs and 157 re-LTs (9.7%) in 1,462 patients. A total of 119 retransplants (50 females, 69 males) were analyzed after consideration of exclusion criteria: recipient age <16 years, second re-LT, primary LT as split-liver or living-related LT, or combination with renal transplantation or Whipple operation. All patients received a whole-size organ. Mean follow-up was 62 months (6 days to 187 months). The main indications for re-LT were initial nonfunction (26.9%), recurrence of viral-induced hepatitis (20.2%), or acute and chronic rejection or thrombosis of the hepatic artery (both 16.8%). The main causes of death were bacterial infections (26.0%) as well as bleeding complications or recurrence of disease (both 16.0%) within the first postoperative month. Overall, 50 out of 119 patients (42%) died after re-LT, 26 patients within the first 3 months and 38 within 1 year. Overall patient survival was 89.9% after 1 month, 78.2% after 1 year, and 67.1% after 5 years. In conclusion, our study showed good clinical results after re-LT. Apart from the changing indications for re-LT with an increasing amount of initial organ failure and hepatic artery thrombosis, the analysis also showed a decreasing amount of complications such as rejection, ischemic type biliary lesions, and recurrence of the disease with unchanged outcome over a period of 15 years.
编辑：ache
作者：fitzmann R，Benscheidt B，Langrehr JM，Schumacher G，Neuhaus R，Neuhaus P。
消息来源：《肝移植》杂志。2007年2月。刊号：13（2）：248-57。
影响因子：4.225（2005）
与首次肝移植（LT）相比，再次肝移植（re-LT）的疗效不佳仍是主要问题。本研究的目的是分析Charite Virchow诊所15年间再次肝移植（re-LT）患者的变化与预后。1989到2003年间，我们共为1462位患者完成了1619例肝移植，其中157例是再次肝移植。我们共分析了119位再次肝移植患者（女性50位，男性69位），应用的排除标准包括：患者年龄小于16岁、第三次肝移植、首次肝移植为劈裂式肝移植或活体肝移植、肝肾联合移植或者肝移植联合Whipple手术。所有的患者都接受全肝再移植。平均随访时间为62个月（6天到187个月不等）。再次肝移植的主要适应症包括原发性失功（26.9%）、肝炎病毒复发（20.2%）、肝动脉的急、慢性排斥及肝动脉血栓形成（各占16.8%）。患者死亡的主要原因为细菌感染（26.0%）、术后一个月内的出血和疾病复发（后两者都为16%）。总得来说，119位患者中，50位（42%）死于re-LT术后，26位在3个月内死亡，38位在1年内死亡。所有患者的一个月生存率为89.9%，一年生存率为78.2%，五年生存率为67.1%。结论，研究证明re-LT术后的临床效果好。但早期器官衰竭和肝动脉血栓形成增多，分析同样也指出了排异、缺血型胆道病变等并发症在减少。基础疾病复发率15年来一直保持稳定。
Title:Trends and experiences in liver retransplantation over 15 years.
Author:Pfitzmann R, Benscheidt B, Langrehr JM, Schumacher G, Neuhaus R, Neuhaus P.
Source:Liver Transpl. 2007 Feb;13(2):248-57.
IF:4.225(2005)
Compared to primary liver transplantation (LT), the inferior results in the outcome of liver retransplantation (re-LT) continue to be a major challenge. The purpose of this study was to analyze changes in and outcomes of re-LT over a period of 15 years at the Charite Virchow Clinic. Between 1989 and 2003, we performed 1,619 LTs and 157 re-LTs (9.7%) in 1,462 patients. A total of 119 retransplants (50 females, 69 males) were analyzed after consideration of exclusion criteria: recipient age <16 years, second re-LT, primary LT as split-liver or living-related LT, or combination with renal transplantation or Whipple operation. All patients received a whole-size organ. Mean follow-up was 62 months (6 days to 187 months). The main indications for re-LT were initial nonfunction (26.9%), recurrence of viral-induced hepatitis (20.2%), or acute and chronic rejection or thrombosis of the hepatic artery (both 16.8%). The main causes of death were bacterial infections (26.0%) as well as bleeding complications or recurrence of disease (both 16.0%) within the first postoperative month. Overall, 50 out of 119 patients (42%) died after re-LT, 26 patients within the first 3 months and 38 within 1 year. Overall patient survival was 89.9% after 1 month, 78.2% after 1 year, and 67.1% after 5 years. In conclusion, our study showed good clinical results after re-LT. Apart from the changing indications for re-LT with an increasing amount of initial organ failure and hepatic artery thrombosis, the analysis also showed a decreasing amount of complications such as rejection, ischemic type biliary lesions, and recurrence of the disease with unchanged outcome over a period of 15 years.
编辑：ache
作者: 丁香园集体编译
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