单中心成人再次肝移植经验总结

Experience Summary of Single-Center Adult Liver Retransplantation

摘要: 本研究回顾性分析了青岛大学附属医院器官移植中心2013年1月至2023年12月实施的47例再次肝移植病例，占同期肝移植总数的3.72%，旨在探讨其临床特征及预后影响因素。结果显示，导致再次肝移植主要病因包括胆道并发症(10例)、移植肝肝硬化(8例)及血管并发症(3例)。本中心成人再次肝移植术后短期(≤90天)死亡率为24.3%，1年、3年和5年总体生存率分别为51%、39%和24%。发现术前MELD评分、Child-Pugh评分、术中出血量、冷缺血时间、输血浆量及ICU滞留时间与术后短期死亡显著相关，经检验具备统计学意义。对比2013~2018年(早期组)与2019~2023年(成熟期组)，成熟期组术中出血量、输血浆量及ICU时间显著降低，具备统计学意义，但两组再次肝移植术后短期并发症发生率、术后短期死亡率、长期生存率差异无统计学意义。研究表明，经验积累可优化手术技术及围术期管理，而术前肝功能状态、手术复杂程度及凝血功能是影响预后的关键因素。该结果与国内外研究趋势一致，提示通过提升手术技巧及综合管理可改善再次肝移植患者的生存结局。

Abstract: This study retrospectively analyzed 47 cases of liver retransplantation performed at the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from January 2013 to December 2023, accounting for 3.72% of the total liver transplantation cases during the same period. The aim was to explore the clinical characteristics and prognostic factors. The results showed that the main causes of liver retransplantation included biliary complications (10 cases), liver cirrhosis of the transplanted liver (8 cases), and vascular complications (3 cases). The short-term (≤90 days) mortality rate after adult liver retransplantation in this center was 24.3%, and the overall survival rates at 1 year, 3 years, and 5 years were 51%, 39%, and 24%, respectively. It was found that preoperative MELD score, Child-Pugh score, intraoperative blood loss, cold ischemia time, plasma transfusion volume, and ICU stay time were significantly associated with short-term postoperative mortality, and the differences were statistically significant. Compared with the early group (2013~2018) and the mature group (2019~2023), the intraoperative blood loss, plasma transfusion volume, and ICU stay time in the mature group were significantly reduced, and the differences were statistically significant. However, there were no statistically significant differences in the short-term complication rate, short-term mortality rate, and long-term survival rate after liver retransplantation between the two groups. The study indicated that the accumulation of experience can optimize surgical techniques and perioperative management, and preoperative liver function status, surgical complexity, and coagulation function are key factors affecting prognosis. The results are consistent with the research trends at home and abroad, suggesting that improving surgical skills and comprehensive management can improve the survival outcomes of patients undergoing liver retransplantation.