再次肝移植危险因素分析的单中心经验总结
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摘要
目的探讨再次肝移植预后的相关危险因素。方法回顾性分析2000年1月—2015年12月再次肝移植患者的临床资料。观察再次肝移植患者的生存状态与各项临床指标的关系。采用二元Logistic回归法分析术后生存相关危险因素。结果再移植术后1、3、5年总体累计生存率分别为63%、52.4%和51.6%,手术时间、术前胆红素水平、术中输血量及术后重症监护病房(intensive care unit, ICU)滞留时间等因素与患者再次肝移植术后生存率有显著相关性。按时间分组,将2000—2004年设为早期组,2005—2015年设为成熟期组。早期组再移植术后1、3、5年累计生存率分别为41.7%、28.6%和28.6%,成熟期组术后1、3、5年累计生存率分别为65.5%、56.1%和54.4%。结论再次肝移植预后不良的因素与患者术前胆红素水平、手术复杂程度及手术经验密切相关。
Objective To investigate the risk factors for the prognosis of liver retransplantation.Methods The clinical data of patients undergoing liver retransplantation from January 2000 to December2015 were retrospectively analyzed.The risk factors related to survival were analyzed by binary logistic regression.Results The 1,3 and 5 years overall cumulative survival rates were 63%,52.4% and 51.6%,respectively.There were significant correlations between the survival rates and the factors such as operation years,preoperative bilirubin level,intraoperative blood transfusion volume,and post-operative intensive care unit(ICU) detention maturity group was established from 2005 to 2015.The 1,3 and 5 years cumulative survival rates in the early group were 41.7%,28.6% and 28.6%,respectively,while those in the maturity group were 65.5%,56.1% and 54.4%,respectively.Conclusion The prognostic factors of retransplantation were closely related to preoperative bilirubin level,surgical complexity and surgical experience.
Objective To investigate the risk factors for the prognosis of liver retransplantation.Methods The clinical data of patients undergoing liver retransplantation from January 2000 to December2015 were retrospectively analyzed.The risk factors related to survival were analyzed by binary logistic regression.Results The 1,3 and 5 years overall cumulative survival rates were 63%,52.4% and 51.6%,respectively.There were significant correlations between the survival rates and the factors such as operation years,preoperative bilirubin level,intraoperative blood transfusion volume,and post-operative intensive care unit(ICU) detention maturity group was established from 2005 to 2015.The 1,3 and 5 years cumulative survival rates in the early group were 41.7%,28.6% and 28.6%,respectively,while those in the maturity group were 65.5%,56.1% and 54.4%,respectively.Conclusion The prognostic factors of retransplantation were closely related to preoperative bilirubin level,surgical complexity and surgical experience.
引文
[1]Montenovo MI,Hansen RN,Dick AA.Outcomes of adult liver retransplant patients in the model for end-stage liver disease era:is it time to reconsider its indications?[J].Clin Transplant,2014,28(10):1099-1104.
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[12]Pfitzmann R,Benscheidt B,Langrehr JM,et al.Trends and experiences in liver retransplantation over 15 years[J].Liver Transpl,2007,13(2):248-257.
[13]Ghabril M,Dickson R,Wiesner R.Improving outcomes of liver retransplantation:an analysis of trends and the impact of Hepatitis C infection[J].Am J Transplant,2008,8(2):404-411.
[14]Marti J,Fuster J,Navasa M,et al.Effects of graft quality on nonurgent liver retransplantation survival:should we avoid high-risk donors?[J].World J Surg,2012,36(12):2914-2922.
[15]Marti J,Charco R,Ferrer J,et al.Optimization of liver grafts in liver retransplantation:an European single-center experience[J].Surgery,2008,144(5):762-769.
[16]Kim H,Lee KW,Yi NJ,et al.Outcome and technical aspects of liver retransplantation:analysis of 25-year experience in a single major center[J].Transplant Proc,2015,47(3):727-729.
[17]Biggins SW.Futility and rationing in liver retransplantation:when and how can we say no?[J].J Hepatol,2012,56(6):1404-1411.
[18]Kim HJ,Larson JJ,Lim YS,et al.Impact of MELD on waitlist outcome of retransplant candidates[J].Am J Transplant,2010,10(12):2652-2657.
[19]Rana A,Petrowsky H,Kaplan B,et al.Early liver retransplantation in adults[J].Transpl Int,2014,27(2):141-151.
[20]Doyle HR,Morelli F,McMichael J,et al.Hepatic Retransplantation-an analysis of risk factors associated with outcome[J].Transplantation,1996,61(10):1499-1505.
[21]Yao FY,Saab S,Bass NM,et al.Prediction of survival after liver retransplantation for late graft failure based on preoperative prognostic scores[J].Hepatology,2004,39(1):230-238.
[22]Schaubel DE,Guidinger MK,Biggins SW,et al.Survival benefitbased deceased-donor liver allocation[J].Am J Transplant,2009,9(4 Pt 2):970-981.
[23]Burton JR,Jr.,Sonnenberg A,Rosen HR.Retransplantation for recurrent hepatitis C in the MELD era:maximizing utility[J].Liver Transpl,2004,10(10 Suppl 2):S59-64.(收稿日期:2019-01-13)
[2]Busuttil RW,Farmer DG,Yersiz H,et al.Analysis of long-term outcomes of 3200 liver transplantations over two decades[J].Ann Surg,2005,241(6):905-918.
[3]Jain A,Reyes J,Kashyap R,et al.Long-term survival after liver transplantation in 4,000 consecutive patients at a single center[J].Ann Surg,2000,232(4):490-500.
[4]Marudanayagam R,Shanmugam V,Sandhu B,et,al.Liver retransplantation in adults:a singlecentre,25-year experience[J].HPB,2010,12(3):217-224.
[5]Edwards E,Harper A.Does MELD work for relisted candidates?[J].Liver Transpl,2004,10(Suppl):10-16.
[6]Kim HJ,Larson JJ,Lim YS,et al.Impact of MELD on waitlist outcome of retransplant candidates[J].Am J Transplant 2010,10(12):2652-2657.
[7]Kitchens WH,Yeh H,Markmann JF.Hepatic retransplant:what have we learned?[J].Clin Liver Dis,2014,18(3):731-751.
[8]Magee JC,Barr ML,Basadonna GP,et al.Repeat organ transplantation in the United States,1996-2005[J].Am J Transplant,2007,7(5 Pt 2):1424-1433.
[9]Watt KD,Lyden ER,McCashland TM.Poor survival after liver retransplantation:is hepatitis C to blame?[J].Liver Transpl,2003,9(10):1019-1024.
[10]Brooks JT,Koizumi N,Neglia E,et al.Improved retransplant outcomes:early evidence of the share35 impact[J].HPB(Oxford),2018,20(7):649-657.
[11]Markmann JF,Markowitz JS,Yersiz H,et al.Longterm survival after retransplantation of the liver[J].Ann Surg,1997,226(4):408-420.
[12]Pfitzmann R,Benscheidt B,Langrehr JM,et al.Trends and experiences in liver retransplantation over 15 years[J].Liver Transpl,2007,13(2):248-257.
[13]Ghabril M,Dickson R,Wiesner R.Improving outcomes of liver retransplantation:an analysis of trends and the impact of Hepatitis C infection[J].Am J Transplant,2008,8(2):404-411.
[14]Marti J,Fuster J,Navasa M,et al.Effects of graft quality on nonurgent liver retransplantation survival:should we avoid high-risk donors?[J].World J Surg,2012,36(12):2914-2922.
[15]Marti J,Charco R,Ferrer J,et al.Optimization of liver grafts in liver retransplantation:an European single-center experience[J].Surgery,2008,144(5):762-769.
[16]Kim H,Lee KW,Yi NJ,et al.Outcome and technical aspects of liver retransplantation:analysis of 25-year experience in a single major center[J].Transplant Proc,2015,47(3):727-729.
[17]Biggins SW.Futility and rationing in liver retransplantation:when and how can we say no?[J].J Hepatol,2012,56(6):1404-1411.
[18]Kim HJ,Larson JJ,Lim YS,et al.Impact of MELD on waitlist outcome of retransplant candidates[J].Am J Transplant,2010,10(12):2652-2657.
[19]Rana A,Petrowsky H,Kaplan B,et al.Early liver retransplantation in adults[J].Transpl Int,2014,27(2):141-151.
[20]Doyle HR,Morelli F,McMichael J,et al.Hepatic Retransplantation-an analysis of risk factors associated with outcome[J].Transplantation,1996,61(10):1499-1505.
[21]Yao FY,Saab S,Bass NM,et al.Prediction of survival after liver retransplantation for late graft failure based on preoperative prognostic scores[J].Hepatology,2004,39(1):230-238.
[22]Schaubel DE,Guidinger MK,Biggins SW,et al.Survival benefitbased deceased-donor liver allocation[J].Am J Transplant,2009,9(4 Pt 2):970-981.
[23]Burton JR,Jr.,Sonnenberg A,Rosen HR.Retransplantation for recurrent hepatitis C in the MELD era:maximizing utility[J].Liver Transpl,2004,10(10 Suppl 2):S59-64.(收稿日期:2019-01-13)