肝移植治疗终末期自身免疫性肝病的预后分析

邹游; 张磊; 李瑞东; 郭闻渊; 丁国善; 傅志仁; 王正昕

doi:10.3969/j.issn.1674-7445.2014.04.006

肝移植治疗终末期自身免疫性肝病的预后分析

doi: 10.3969/j.issn.1674-7445.2014.04.006

200003 上海, 第二军医大学附属长征医院器官移植中心

基金项目:

上海市科委国际合作项目 11410708700

详细信息

通讯作者:
王正昕,Email:wangzhxk@hotmail.com

中图分类号: R617
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- 被引次数: 0
出版历程
- 收稿日期: 2014-03-26
- 网络出版日期: 2021-01-19
- 刊出日期: 2014-07-15

Prognostic analysis of liver transplantation in treating patients with end-stage autoimmune liver disease

Organ Transplantation Center, Affiliated Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China

摘要

摘要: 目的探讨肝移植治疗终末期自身免疫性肝病(AILD)的预后情况。方法回顾性分析1996年5月至2013年4月在第二军医大学附属长征医院实施原位肝移植术的48例终末期AILD受者的临床资料。计算受者的术后累积生存率,分析死亡病例的死因,了解术后排斥反应、病毒性肝炎新发感染及AILD复发情况。结果 48例AILD受者中,存活38例,AILD受者术后5年累积生存率为76%。10例死亡受者的死亡原因包括多器官功能衰竭、移植肝衰竭、脓毒症、肺部感染、出血、肝动脉栓塞、肾衰竭。48例AILD受者中,肝移植术后发生急性排斥反应者9例(19%),有3例分别在术后1~2年内新发乙型肝炎病毒感染,有2例原发性胆汁性肝硬化受者于术后2年出现原发病复发,经积极治疗均长期生存。结论终末期AILD肝移植受者多数可获得长期生存,应重视肝移植术后早期免疫抑制方案的制定,预防感染及排斥反应和术后新发病毒性肝炎,及时发现原发病复发等问题。
- 肝移植 /
- 自身免疫性肝病 /
- 自身免疫性肝炎 /
- 原发性胆汁性肝硬化 /
- 原发性硬化性胆管炎 /
- 肾上腺皮质激素
Abstract: Objective To investigate the prognosis of patients underwent liver transplantation (LT) for end-stage autoimmune liver disease (AILD). Methods Clinical data of 48 patients with end-stage AILD undergoing LT from May 1996 to April 2013 in Affiliated Changzheng Hospital of the Second Military Medical University were analyzed retrospectively. The postoperative cumulative survival rates of the recipients were calculated, and the cause of death was analyzed. The postoperative rejections, new-onset viral hepatitis and AILD recurrence were analyzed. Results In 48 AILD recipients, 38 cases survived and the postoperative 5-year cumulative survival rate was 76%. Causes of death for the 10 dead cases were multiple organ failure, liver graft failure, sepsis, pulmonary infection, hemorrhage, hepatic artery embolization and renal failure. In 48 AILD recipients, 9 cases (19%) suffered acute rejection after operation, 3 cases suffered new-onset hepatitis B infection in 1-2 years after operation, 2 recipients suffered primary disease (primary biliary cirrhosis) recurrence 2 years after operation and all survived for a long term after positive treatments. Conclusions Most liver transplant recipients with end-stage AILD can obtain a long-term survival. Attentions should be paid on the immunosuppressive regimens in early period after LT, prevention of infection, rejection and postoperative new-onset viral hepatitis, timely diagnosis of primary disease recurrence.
- Liver transplantation /
- Autoimmune liver disease /
- Autoimmune hepatitis /
- Primary biliary cirrhosis /
- Primary sclerosing cholangitis /
- Adrenocortical hormone

HTML全文

表 1 10例终末期自身免疫性肝病肝移植受者死亡病例的临床资料

Table 1. Clinical data of 10 dead cases with end-stage autoimmune liver disease after liver transplantation

例序	AILD分型	术前MELD评分 (分)	术前Child-Pugh 评分(分)	术后存活时间 (d)	术后感染发生情况	术后排斥反应发生情况	死亡原因
1	PBC	32	11	10	有	无	多脏器功能衰竭
2	AIH	26	13	97	有	无	移植肝衰竭
3	AIH	17	12	0^a	无	无	术中大出血
4	PBC	28	11	13	有	无	多脏器功能衰竭
5	PBC	19	12	501	有	有	多脏器功能衰竭
6	PBC	11	8	48	有	有	脓毒症
7	PBC	38	12	2	有	无	多脏器功能衰竭
8	PBC	31	12	14	有	无	肺部感染
9	PBC	23	10	46	有	无	肝动脉栓塞
10	PBC	20	10	398	无	无	肾衰竭
注：MELD为终末期肝病模型；^a为术中死亡

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